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<1>
Accession Number
2015657396
Authors
Goto T. Kadota Y. Mori T. Yamashita S.-I. Horio H. Nagayasu T. Iwasaki A.
Institution
(Goto, Kadota, Mori, Yamashita, Horio, Nagayasu, Iwasaki) Guidelines
Committees of Japanese Association for Chest Surgery, Kyoto, Japan
(Goto) Division of General Thoracic Surgery, Department of Surgery, School
of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan
(Kadota) Department of General Thoracic Surgery, Osaka Prefectural Medical
Center for Respiratory and Allergic Diseases, Osaka, Japan
(Mori) Department of Thoracic Surgery, Kumamoto University Hospital,
Kumamoto, Japan
(Yamashita, Iwasaki) Department of General Thoracic, Breast, and Pediatric
Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
(Horio) Department of General Thoracic Surgery, Tokyo Metropolitan Cancer
and Infectious Diseases Center, Tokyo, Japan
(Nagayasu) Division of Surgical Oncology, Department of Surgery, Nagasaki
University Graduate School of Biomedical Sciences, Nagasaki, Japan
Title
Video-assisted thoracic surgery for pneumothorax: republication of a
systematic review and a proposal by the guideline committee of the
Japanese Association for Chest Surgery 2014.
Source
General Thoracic and Cardiovascular Surgery. 63 (1) (pp 8-13), 2015. Date
of Publication: 2015.
Publisher
Springer-Verlag Tokyo
Abstract
Objective: The purpose of this consensus conference was to determine
whether video-assisted thoracic surgery (VATS) improves clinical outcomes
compared with conventional thoracotomy in patients undergoing surgery for
pneumothorax, and to outline evidence-based recommendations for the use of
VATS. Methods: Before the consensus conference, the best available
evidence was reviewed, with systematic reviews, randomized trials, and
nonrandomized trials all taken into consideration in descending order of
validity and importance. At the consensus conference, evidence-based
interpretative statements were created, and consensus processes were used
to determine the ensuing recommendations. The Medical Information Network
Distribution Service in Japan (Minds) system was used to label the levels
of evidence for the references and the classes of recommendations. Results
and recommendations: The consensus panel agreed upon the following
statements and recommendations for patients with pneumothorax undergoing
surgery: 1. VATS is broadly indicated as surgery for pneumothorax. 2. VATS
is judged to be less invasive, as it results in minimal postoperative
pain, the periods of chest tube placement and hospitalization are short,
and it shows a trend toward early realization of social integration. 3.
There is no difference in terms of safety and complications between VATS
and open thoracotomy. 4. As it is anticipated that VATS will result in a
higher recurrence rate than open thoracotomy, it may be desirable to add a
supplemental procedure during surgery. In summary, VATS can be recommended
as pneumothorax surgery (Recommendation grade: Level B).

<2>
Accession Number
2015895313
Authors
Stempien-Otero A. Helterline D. Plummer T. Farris S. Prouse A. Polissar N.
Stanford D. Mokadam N.A.
Institution
(Stempien-Otero, Helterline, Plummer, Farris, Prouse) Department of
Medicine, University of Washington, School of Medicine, Seattle, WA,
United States
(Polissar, Stanford) Mountain-Whisper-Light Statistics, Seattle, WA,
United States
(Mokadam) Department of Surgery, University of Washington, School of
Medicine, Seattle, WA, United States
Title
Mechanisms of bone marrow-derived cell therapy in ischemic cardiomyopathy
with left ventricular assist device bridge to transplant.
Source
Journal of the American College of Cardiology. 65 (14) (pp 1424-1434),
2015. Date of Publication: 14 Apr 2015.
Publisher
Elsevier USA
Abstract
Background Clinical trials report improvements in function and perfusion
with direct injection of bone marrow cells into the hearts of patients
with ischemic cardiomyopathy. Preclinical data suggest these cells improve
vascular density, which would be expected to decrease fibrosis and
inflammation. Objectives The goal of this study was to test the hypothesis
that bone marrow stem cells (CD34+) will improve histological measurements
of vascularity, fibrosis, and inflammation in human subjects undergoing
left ventricular assist device (LVAD) placement as a bridge to cardiac
transplantation. Methods Subjects with ischemic cardiomyopathy who were
scheduled for placement of an LVAD as a bridge to transplantation
underwent bone marrow aspiration the day before surgery; the bone marrow
was processed into cell fractions (bone marrow mononuclear cells, CD34+,
and CD34-). At LVAD implantation, all fractions and a saline control were
injected epicardially into predetermined areas and each injection site
marked. At the time of transplantation, injected areas were collected.
Data were analyzed by paired Student t test comparing the effect of cell
fractions injected within each subject. Results Six subjects completed the
study. There were no statistically significant differences in
complications with the procedure versus control subjects. Histological
analysis indicated that myocardium injected with CD34+ cells had decreased
density of endothelial cells compared to saline-injected myocardium. There
were no significant differences in fibrosis or inflammation between
groups; however, density of activated fibroblasts was decreased in both
CD34+ and CD34- injected areas. Conclusions Tissue analysis does not
support the hypothesis that bone marrow-derived CD34+ cells promote
increased vascular tissue in humans with ischemic cardiomyopathy via
direct injection.

<3>
Accession Number
2015897965
Authors
Xie Y. Shen S. Zhang J. Wang W. Zheng J.
Institution
(Xie) Department of Cardiothoracic surgery, Zhejiang Provincial People's
Hospital, Hangzhou, Zhejiang, China
(Shen, Wang) Department of Anesthesiology, Zhejiang Provincial People's
Hospital, Hangzhou, Zhejiang, China
(Zhang) Department of Orthopedics, Zhejiang Provincial People's Hospital,
Hangzhou, Zhejiang, China
(Zheng) Department of Probability and Statistics, School of Mathematical
Sciences, Beijing University, Beijing, China
Title
The efficacy, safety and cost-effectiveness of intra-operative cell
salvage in high-bleeding-risk cardiac surgery with cardiopulmonary bypass:
A prospective randomized and controlled trial.
Source
International Journal of Medical Sciences. 12 (4) (pp 322-328), 2015. Date
of Publication: 01 Apr 2015.
Publisher
Ivyspring International Publisher
Abstract
Objective: Intra-operative cell salvage (CS) was reported to be
ineffective, safe and not cost-effective in low-bleeding-risk cardiac
surgery with cardiopulmonary bypass (CPB), but studies in
high-bleeding-risk cardiac surgery are limited. The objective of this
study is to evaluate the efficacy, safety and cost-effectiveness of
intra-operative CS in high-bleeding-risk cardiac surgery with CPB.
Methods: One hundred and fifty patients were randomly assigned to either
with intra-operative CS group (Group CS) or without intra-operative CS
group (Group C). Study endpoints were defined as perioperative allogeneic
red blood cell (RBC) transfusion, perioperative impairment of blood
coagulative function, postoperative adverse events and costs of
transfusion-related. Results: Both the proportion and quantity of
perioperative allogeneic RBC transfusion were significantly lower in Group
CS than that in Group C (p=0.0002, <0.0001, respectively). The incidence
of residual heparin and total impairment of blood coagulative function in
the 24 hours after surgery, the incidence of postoperative excessive
bleeding, were significantly higher in Group CS than that in Group C
(p=0.018, 0.042, 0.034, respectively). Cost of both allogeneic RBC
transfusion and total allogeneic blood transfusion were significantly
lower in Group CS than that in Group C (p<0.001, =0.002, respectively).
Cost of total blood transfusion was significantly higher in Group CS than
that in Group C (p =0.001). Conclusion: Intra-operative CS in
high-bleeding-risk cardiac surgery with CPB is effective, generally safe,
and cost-effective in developed countries but not in China.

<4>
Accession Number
2015748386
Authors
Patti G. Pelliccia F. Gaudio C. Greco C.
Institution
(Patti) Department of Cardiovascular Sciences, Campus Bio-Medico
University of Rome, Rome, Italy
(Pelliccia, Gaudio, Greco) Department of Heart and Great Vessels Attilio
Reale, La Sapienza University, Rome, Italy
Title
Meta-analysis of net long-term benefit of different therapeutic strategies
in patients with cryptogenic stroke and patent foramen ovale.
Source
American Journal of Cardiology. 115 (6) (pp 837-843), 2015. Date of
Publication: 15 Mar 2015.
Publisher
Elsevier Inc.
Abstract
We pooled available data on follow-up events in patients with patent
foramen ovale and cryptogenic stroke to evaluate the net clinical benefit
of different therapeutic strategies (percutaneous closure vs antiplatelet
vs anticoagulant therapy). MEDLINE/PubMed and Cochrane databases and
reviewed cited references to identify relevant studies were used; 3,311
patients from 21 clinical studies, both observational and randomized, with
follow-up <12 months were overall included. Net clinical benefit was
evaluated considering the cumulative incidence of both stroke and/or
transient ischemic attack and major bleeding events. Anticoagulant therapy
was more effective than antiplatelet therapy in preventing recurrent
stroke and/or transient ischemic attack (event rates: 7.7% vs 9.8%,
respectively, p = 0.03), but at the price of more than sixfold greater
risk of major bleeding (7.1% vs 1.3%; odds ratio 6.49, 95% confidence
interval 3.25 to 12.99, p <0.00001). Patent foramen ovale closure was
associated over the long term with significant net clinical benefit versus
both antiplatelet and anticoagulant therapy; such benefit was driven by
50% relative reduction of stroke and/or transient ischemic attack versus
antiplatelet therapy and by 82% relative reduction of major bleeding
versus anticoagulant therapy. In conclusion, results of this large
study-level meta-analysis may influence practice patterns in patients with
patent foramen ovale and cryptogenic stroke; an individualized approach
tailored on both the risk of recurrent cerebral events and the bleeding
risk should be used to identify the best therapeutic option (percutaneous
closure vs antiplatelet therapy vs anticoagulant therapy).

<5>
Accession Number
2015733925
Authors
Hahn R.T. Pibarot P. Weissman N.J. Rodriguez L. Jaber W.A.
Institution
(Hahn) Columbia University Medical Center, New York-Presbyterian Hospital,
177 Fort Washington Avenue, New York, NY 10032, United States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Weissman) Medstar Health Research Institute, Washington, DC, United
States
(Rodriguez, Jaber) Cleveland Clinic Foundation, Cleveland, OH, United
States
Title
Assessment of paravalvular aortic regurgitation after transcatheter aortic
valve replacement: Intra-core laboratory variability.
Source
Journal of the American Society of Echocardiography. 28 (4) (pp 415-422),
2015. Date of Publication: 01 Apr 2015.
Publisher
Mosby Inc.
Abstract
Background There is significant disparity in the reported incidence of
moderate and severe paravalvular aortic regurgitation (PAR) between the
Placement of Aortic Transcatheter Valves (PARTNER) I and PARTNER II
trials, which may be related to the echocardiographic methodologies used
by separate core laboratories. To further explore the variability in
echocardiographic interpretation of PAR, agreement between the grading of
PAR by the core laboratory of PARTNER IIB was compared with that by a
consortium of echocardiography core laboratory directors. Methods The
PARTNER IIB core laboratory reevaluated patients using primarily the
circumferential extent of the regurgitant jet for PAR. A consortium of
echocardiography core laboratory directors was formed to evaluate the
echocardiographic images and to grade PAR and central and total aortic
regurgitation in a randomly chosen subset of the randomized patients in
the PARTNER IIB trial using a multiwindow, multiparametric approach. Both
a four-class scale (none or trace, mild, moderate, and severe) and a
seven-class (none, trace, mild, mild to moderate, moderate, moderate to
severe, and severe) scale were used. Levels of grading agreement between
the consortium and original core laboratory in both scales were determined
using weighted kappa statistics. Results Only 87 patients assessed for PAR
by the consortium could be paired with readings by the PARTNER IIB core
laboratory. Using the four-class grading scheme the weighted kappa
statistic for PAR was 0.481 (95% confidence limits, 0.367, 0.595). Using
the seven-class scale, the weighted kappa statistic for PAR was 0.517 (95%
confidence limits, 0.431, 0.607). For either grading scheme, 15.9% of
patients graded by the PARTNER IIB core laboratory as having moderate PAR
would have been graded as having mild PAR using the multiparametric
approach. Similar results were seen for central and total aortic
regurgitation assessments. Conclusions Using primarily the circumferential
extent criteria, the PARTNER IIB core laboratory overestimated the
severity of PAR compared to the consortium using a multi-parametric
approach. Although a more granular classification scheme for PAR may
slightly improve concordance between core laboratories, differences in the
incidence of moderate or severe PAR are likely related to differences in
grading methodology. A multiparametric approach is advocated, and other
echocardiographic methods for assessing PAR deserve further study.

<6>
Accession Number
2015665670
Authors
Deb S. Fremes S.E.
Institution
(Deb, Fremes) Schulich Heart Centre, University of Toronto, University of
Toronto, Toronto, ON, Canada
Title
To bypass or stent' the changing rules of an advancing game.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (3) (pp 679-681),
2015. Date of Publication: 01 Mar 2015.
Publisher
Mosby Inc.

<7>
Accession Number
2015643751
Authors
Sant'Anna R.T. Leiria T.L. Nascimento T. Sant'Anna J.R.M. Kalil R.A.K.
Lima G.G. Verma A. Healey J.S. Birnie D.H. Essebag V.
Institution
(Sant'Anna, Leiria, Sant'Anna, Kalil, Lima) Instituto de Cardiologia Do
Rio Grande Do sul, Servico de Cirurgia Cardiovascular, Av. Princesa Isabel
395, Santana Porto Alegre - RS 90620-000, Brazil
(Nascimento, Essebag) McGill University Health Centre, Montreal, Canada
(Verma) Southlake Regional Health Centre, Newmarket, Canada
(Healey) Population Health Research Institute, Hamilton, Canada
(Birnie) University of Ottawa Heart Institute, Ottawa, Canada
(Essebag) Hopital Sacre-Coeur de Montreal, Montreal, Canada
Title
Meta-analysis of continuous oral anticoagulants versus heparin bridging in
patients undergoing CIED surgery: Reappraisal after the BRUISE study.
Source
PACE - Pacing and Clinical Electrophysiology. 38 (4) (pp 417-423), 2015.
Date of Publication: 01 Apr 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Background Management of patients treated with oral anticoagulation (OAC)
requiring a cardiovascular implantable electronic device (CIED) surgery is
a challenge that requires balancing the risk of bleeding complications
with the risk of thromboembolic events. Recently the approach of
performing these procedures while the patient remains with a therapeutic
international normalized ratio has gained interest due to several
publications showing its relative safety. Objectives To evaluate the
safety and effectiveness of continuous use of OAC compared with heparin
bridging in the perioperative setting of CIED surgery using a
meta-analysis. Methods A systematic review of PubMed/MEDLINE, Ovid, and
Elsevier databases was performed. Eligible randomized controlled trials
and cohort studies were included. The outcomes studied were risk of
clinically significant bleeding and of thromboembolic events. Our analysis
was restricted to OAC with vitamin K antagonists. Results Of 560
manuscripts initially considered relevant, seven were included in the
meta-analysis, totaling 2,191 patients. Data are reported as odds ratios
(ORs) with confidence interval (CI) of 95%. Maintenance of OAC was
associated with a significantly lower risk of postoperative bleeding
compared with heparin bridge (OR = 0.25, 95% CI 0.17-0.36, P < 0.00001).
There was no difference noted in the risk of thromboembolic events between
the two strategies (OR = 1.86, 95% CI 0.29-12.17, P = 0.57). Conclusions
Uninterrupted use of OAC in the perioperative of CIED surgery was
associated with a reduced risk of bleeding. This strategy should be
considered the preferred one in patients at moderate-to-high risk of
thromboembolic events.

<8>
Accession Number
2014959955
Authors
Fernando H.C. Landreneau R.J. Mandrekar S.J. Nichols F.C. Dipetrillo T.A.
Meyers B.F. Heron D.E. Hillman S.L. Jones D.R. Starnes S.L. Tan A.D. Daly
B.D.T. Putnam J.B.
Institution
(Fernando) Department of Cardiothoracic Surgery, Boston Medical Center, 88
East Newton St, Boston, MA 02118, United States
(Landreneau, Heron, Daly) University of Pittsburgh, Pittsburgh, PA, United
States
(Mandrekar, Hillman, Tan) Alliance Statistics and Data Center, Mayo
Clinic, Rochester, MN, United States
(Nichols) Mayo Clinic, Rochester, MN, United States
(Dipetrillo) Rhode Island Hospital, Providence, RI, United States
(Meyers) Washington University of St Louis, St Louis, Mo, United States
(Jones) University of Virginia, Charlottesville, VA, United States
(Starnes) University of Cincinnati, Cincinnati, OH, United States
(Putnam) Vanderbilt University Medical Center, Nashville, TN, United
States
Title
Analysis of longitudinal quality-of-life data in high-risk operable
patients with lung cancer: Results from the ACOSOG Z4032 (Alliance)
multicenter randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (3) (pp 718-726),
2015. Date of Publication: 01 Mar 2015.
Publisher
Mosby Inc.
Abstract
Background Prior studies have suggested that low baseline quality-of-life
(QOL) scores predict worse survival in patients undergoing lung cancer
surgery. However, these studies involved average-risk patients undergoing
lobectomy. We report QOL results from a multicenter trial, American
College of Surgeons Oncology Group Z4032, which randomized high-risk
operable patients to sublobar resection (SR), or SR with brachytherapy,
and included longitudinal QOL assessments. Methods Global QOL, using the
36-item Short-Form Health Survey (SF36), and the dyspnea score from the
University of California, San Diego Shortness of Breath Questionnaire
(SOBQ) scale, was measured at baseline, 3, 12, and 24 months. SF36
physical component summary (PCS) and mental component summary (MCS) scores
were standardized and adjusted for age and gender normals, with scores <50
indicating below-Average health status. SOBQ scores were transformed to a
0-100 (poor-excellent) scale. Aims were to: (1) determine the impact of
baseline scores on recurrence-free survival, overall survival, and 30-day
adverse events (AEs); and (2) identify subgroups (surgical approach,
resection type. tumor location, tumor size, respiratory function) with a
>10-point decline or improvement in QOL after SR. Results Two hundred
twelve eligible patients were included. There were no significant
differences in baseline QOL scores between arms. Median baseline PCS, MCS,
and SOBQ scores were 42.7, 51.1, and 70.8, respectively. There were no
differences in grade-3+ AEs, overall survival, or recurrence-free survival
in patients with baseline scores <median versus >median values, except for
a significantly worse overall survival for patients with baseline SOBQ
scores <median value. There were no significant differences between the
study arms in percentage change of QOL scores from baseline to 3, 12, or
24 months. Further comparison combining the 2 arms demonstrated a higher
percentage of patients with a >10-point decline in SOBQ scores with
segmentectomy compared with wedge resection (40.5% vs 21.9%, P =.03) at 12
months, with thoracotomy versus video-Assisted thoracic surgery (VATS)
(38.8% vs 20.4%, P =.03) at 12 months, and T1b versus T1a tumors (46.9% vs
23.5%, P =.020) at 24 months. A >10-point improvement in PCS score was
seen at 3 months with VATS versus thoracotomy (16.5% vs 3.6%, P =.02).
Conclusions In high-risk operable patients, poor baseline QOL scores were
not predictive for worse overall or recurrence-free survival, or for
higher risk for AEs following SR. VATS was associated with improvement in
physical function at 3 months, and improved dyspnea scores at 12 months,
lending support for the preferential use of VATS when SR is undertaken.

<9>
Accession Number
2015881938
Authors
Li Y. Han Y. Guan S. Sun Y. Guo L. Yang B. Zang H. Jing Q. Wang X. Ma Y.
Liu X. Li J. Zheng L.
Institution
(Li, Han, Guan, Jing, Wang, Ma, Liu, Li, Zheng) Department of Cardiology,
General Hospital of Shenyang Military Region, 83 Wenhua Road, Shenyang
110016, China
(Sun, Guo) First Affiliated Hospital of Chinese Medical University,
Shenyang, China
(Yang, Zang) No. 463 Hospital of People's Liberation Army, Shenyang, China
Title
Optimal-vs. standard-antiplatelet therapy on platelet function and
long-term clinical outcomes in patients with high on-treatment platelet
reactivity: 2-year outcomes of the multicentre, randomized
Optimal-antiPlatelet Therapy (OPT) trial.
Source
European Heart Journal, Supplement. 17 (pp B23-B31), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Oxford University Press
Abstract
Optimal strategy for the management of high on-treatment platelet
reactivity (HPR), an independent predictor of ischaemic events, is not yet
clear. The aim of this study was to explore the safety and efficacy of
personalized antiplatelet therapy based on platelet function testing in
patients with HPR. A total of 840 patients with HPR who underwent coronary
stenting for acute coronary syndrome (ACS) were randomly assigned in a 1:2
ratio to receive standard dual-antiplatelet therapy (n = 280) or platelet
function-guided optimal-antiplatelet therapy (n = 560). In the optimal
group, patients initially received clopidogrel 150 mg/day on top of
aspirin and switched to triple antiplatelet therapy with additional
cilostazol if repeat platelet function assay after 3 days indicated a
sustained HPR. The primary endpoint was the composite of all-cause death,
myocardial infarction, clinically driven target vessel revascularization
(TVR), or stroke. Optimal therapy resulted in significantly lower 30-day
HPR rate (30.1 vs. 44.3%, P < 0.001). At 1-year follow up, optimal therapy
was associated with significantly lower incidence of primary endpoint
events (2.7 vs. 6.8%, P = 0.006) compared with standard therapy, mainly
due to the reduction of TVR. These beneficial effects were sustained at 2
years (4.5 vs. 9.2%, P = 0.006), with similar bleeding event rates between
groups (7.3 vs. 6.5%, P = 0.565). Optimal-antiplatelet therapy based on
platelet function testing is effective in attenuating HPR and improving
long-term outcomes for ACS patients with no increase in bleeding events.

<10>
Accession Number
2015880959
Authors
Dillon J. Yakub M.A. Kong P.K. Ramli M.F. Jaffar N. Gaffar I.F.
Institution
(Dillon, Yakub, Kong) Department of Cardiothoracic Surgery, National Heart
Institute, 145 Jalan Tun Razak, Kuala Lumpur 50400, Malaysia
(Ramli, Jaffar, Gaffar) Clinical Research Department, National Heart
Institute, Kuala Lumpur, Malaysia
Title
Comparative long-term results of mitral valve repair in adults with
chronic rheumatic disease and degenerative disease: Is repair for
"burnt-out" rheumatic disease still inferior to repair for degenerative
disease in the current era'.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (3) (pp 771-779),
2015. Date of Publication: 01 Mar 2015.
Publisher
Mosby Inc.
Abstract
Objective Mitral valve repair is perceived to be of limited durability for
advanced rheumatic disease in adults. We aim to examine the long-term
outcomes of repair for rheumatic disease, identify predictors of
durability, and compare with repair for degenerative disease. Methods
Rheumatic and degenerative mitral valve repairs in patients aged 40 years
or more were prospectively analyzed. The primary outcomes investigated
were mortality, freedom from reoperation, and valve failure. Logistic
regression analysis was performed to define predictors of poor outcome.
Results Between 1997 and 2011, 253 rheumatic and 148 degenerative mitral
valves were repaired. The age of patients in both groups was similar, with
a mean of 54.1 +/- 8.4 years versus 55.6 +/- 7.3 years (P =.49). Freedom
from reoperation for rheumatic valves at 5 and 10 years was 98.4%,
comparable to 95.3% (P =.12) for degenerative valves. Freedom from valve
failure at 5 and 10 years was 91.4% and 81.5% for rheumatic repairs and
82.5% and 75.4% for degenerative repairs, respectively (P =.15). The
presence of residual mitral regurgitation greater than 2+ before discharge
was the only significant independent predictor of reoperation, whereas
residual mitral regurgitation greater than 2+ and leaflet procedures were
significant risk factors for valve failure. Conclusions The durability of
rheumatic mitral valve repair in the current era has improved and is
comparable to the outstanding durability of repairs for degenerative
disease, even in the adult rheumatic population. Modifications of standard
repair techniques, adherence to the importance of good leaflet coaptation,
and strict quality control with stringent use of intraoperative
transesophageal echocardiography have all contributed to the improved
long-term results.

<11>
Accession Number
2015880934
Authors
Smit Y. Vlayen J. Koppenaal H. Eefting F. Kappetein A.P. Mariani M.A.
Institution
(Smit) Independent Researcher, Leuth, Netherlands
(Vlayen) ME-TA, Rotselaar, Belgium
(Koppenaal) Independent Researcher, Vlissingen, Netherlands
(Eefting) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Kappetein) Department of Cardiothoracic Surgery, Erasmus Medisch Centrum,
Rotterdam, Netherlands
(Mariani) Department of Cardiothoracic Surgery, University Medical Centre
Groningen, University of Groningen, P.O. Box 30.001, Groningen 9700 RB,
Netherlands
Title
Percutaneous coronary invervention versus coronary artery bypass grafting:
A meta-Analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (3) (pp 831-838.e13),
2015. Date of Publication: 01 Mar 2015.
Publisher
Mosby Inc.
Abstract
Objective To compare the effectiveness of percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) in patients
with coronary artery disease. Methods MEDLINE, Embase, and Cochrane
Central were searched, and randomized controlled trials were included.
Outcomes were assessed at maximum available follow-up. Results This
meta-Analysis includes 31 trials with 15,004 patients. As regards death,
more patients died after PCI compared with CABG across all types of
patients (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.3; P
=.05) as well as in patients with multivessel disease (OR, 1.2; 95% CI,
1.0-1.4; P =.02) or diabetes (OR, 1.6; 95% CI, 1.2-2.1; P <.01).
Myocardial infarction occurred as frequently after PCI (OR, 1.2; 95% CI,
0.9-1.5; P =.28). Repeat revascularization was more common after PCI (OR,
4.5; 95% CI, 3.5-5.8; P <.01), with a progressive decline in ORs from the
pre-stent era (OR, 7.0; 95% CI, 5.1-9.7; P <.01), to the bare metal stent
era (OR, 4.5; 95% CI, 3.6-5.5; P <.01), and to the drug-eluting stent era
(OR, 2.5; 95% CI, 1.8-3.4; P <.01). Stroke was more common after CABG (OR,
0.7; 95% CI, 0.5-0.9; P =.01). Conclusions Compared with PCI, CABG had a
lower risk of death in multivessel disease or diabetes patients eligible
for either intervention, a lower risk of repeat revascularization, but a
higher risk of stroke.

<12>
Accession Number
2014706585
Authors
Sannino A. Losi M.A. Schiattarella G.G. Gargiulo G. Perrino C. Stabile E.
Toscano E. Giugliano G. Brevetti L. Franzone A. Cirillo P. Imbriaco M.
Trimarco B. Esposito G.
Institution
(Sannino, Losi, Schiattarella, Gargiulo, Perrino, Stabile, Toscano,
Giugliano, Brevetti, Franzone, Cirillo, Imbriaco, Trimarco, Esposito)
Division of Cardiology, Department of Advanced Biomedical Sciences,
Federico II University, Naples, Italy
Title
Meta-analysis of mortality outcomes and mitral regurgitation evolution in
4,839 patients having transcatheter aortic valve implantation for severe
aortic stenosis.
Source
American Journal of Cardiology. 114 (6) (pp 875-882), 2015. Date of
Publication: 2015.
Publisher
Elsevier Inc.
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective alternative
therapy in selected patients with severe aortic stenosis. The role and
effects of coexistent moderate to severe mitral regurgitation (msMR) in
patients who undergo TAVI remain unclear. Thirteen studies enrolling 4,839
patients who underwent TAVI, including patients with msMR, were considered
in a meta-analysis and analyzed for all-cause-mortality; a further
metaanalysis was performed to assess mitral regurgitation (MR) evolution
after TAVI. In patients with msMR, all-cause-mortality after TAVI was
significantly increased at 30-day (effect size [ES] L0.18, 95% confidence
interval [CI] L0.31 to L0.04, I2 [ 46.51, Q [ 7.48), 1-year (ES L0.22, 95%
CI L0.36 to L0.08, I2 [ 56.20, Q [ 11.41), and 2-year (ES L0.15, 95% CI
L0.27 to L0.02, I2 [ 0.00, Q [ 2.64) follow-up compared with patients with
absent or mild MR, independent of baseline left ventricular ejection
fraction. Interestingly, the impact of msMR on outcomes was statistically
stronger when the CoreValve system was used. TAVI was also associated with
an improvement in MR entity at 3- and 6-month follow-up (overall ES L0.19,
95% CI L0.37 to L0.01, I2 [ 61.52, Q [ 10.39). In conclusion, the presence
of preoperative msMR in patients with severe, symptomatic aortic stenosis
who undergo TAVI negatively affects outcomes after TAVI. In addition, in
the same group of patients, a trend toward a reduction in MR severity was
observed. Whether the decrease in MR severity affects mortality after TAVI
remains to be defined.

<13>
Accession Number
2015880391
Authors
Gemma M. Nicelli E. Gioia L. Moizo E. Beretta L. Calvi M.R.
Institution
(Gemma, Nicelli, Gioia, Moizo, Beretta, Calvi) Department of Anesthesia
and Neurointensive Care, San Raffaele Scientific Institute, Milan 20132,
Italy
Title
Acupuncture accelerates recovery after general anesthesia: A prospective
randomized controlled trial.
Source
Journal of Integrative Medicine. 13 (2) (pp 99-104), 2015. Date of
Publication: 01 Mar 2015.
Publisher
Elsevier (Singapore) Pte Ltd (3 Killiney Road, 08-01, Winsland House I,
Singapore 239519, Singapore)
Abstract
Background Acupuncture anesthesia was created in the 1950's in China and
continues to be used there today during most major surgeries. It is widely
used in China for such complex operations as brain, heart, and abdominal
surgery. It is popular in China because it is economical, practical, and
beneficial to the patients. With acupuncture anesthesia there is less
bleeding during surgery and there is also quicker post-operative recovery.
Objective This randomized prospective study aims at comparing the effect
of two acupoints (Yongquan, KI1 and Renzhong, DU26) with sham acupuncture
and no acupuncture on the time to recovery of consciousness after general
anesthesia by means of the Bispectral Index monitor (BIS). Design,
setting, participants and interventions This is a prospective randomized
controlled study. We randomly assigned 50 patients to 5 groups during
recovery from surgical anesthesia. Four groups had acupuncture on KI1
(group A), DU26 (groups B), both KI1 and DU26 (group C), and sham points
(group D), and one had no acupuncture (group E). Main outcome measures
Bispectral Index (BIS), time to spontaneous eye opening, time to tracheal
extubation, and time to following commands were measured as the main
outcome measures. Results Time to spontaneous eye opening differed among
groups (P=0.002), as well as time to tracheal extubation (P<0.000 1) and
time to following commands (P=0.000 6). BIS values differed significantly
among groups both 5 and 10 min after the end of anesthesia (P<0.000 1 and
P=0.000 4, respectively). BIS values of groups D and E were lower than
those of the other groups and those of group C were higher. The same
pattern was observed also 15 and 30 min after the end of anesthesia,
although the difference among groups was not significant at these time
points (P=0.164 and P=0.104, respectively). Conclusion Acupuncture on DU26
and KI1 accelerates recovery of consciousness after general anesthesia.
Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This
issue may play a role in the optimization of operating room management and
raise interest about the usefulness of acupuncture on unconsciousness
states of different nature.

<14>
Accession Number
2015891129
Authors
Schmit K. Dolor R.J. Schuyler Jones W. Vemulapalli S. Hasselblad V.
Subherwal S. Heidenfelder B. Patel M.R.
Institution
(Schmit) Departments of Community and Family Medicine, Duke University
School of Medicine, Durham, NC, United States
(Hasselblad) Biostatistics and Bioinformatics, Duke University School of
Medicine, Durham, NC, United States
(Dolor) Division of General Internal Medicine, Duke University Medical
Center, Durham, NC, United States
(Schuyler Jones, Vemulapalli, Subherwal, Patel) Division of Cardiology,
Duke University Medical Center, Durham, NC, United States
(Schmit, Dolor, Schuyler Jones, Patel) Duke Clinical Research Institute,
Duke University Medical Center, Durham, NC, United States
(Dolor, Heidenfelder) Duke Evidence-based Practice Center, Duke Clinical
Research Institute, Duke University, Durham, NC, United States
Title
Comparative effectiveness review of antiplatelet agents in peripheral
artery disease.
Source
Journal of the American Heart Association. 3 (6) , 2014. Article Number:
001330. Date of Publication: 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)

<15>
[Use Link to view the full text]
Accession Number
2015874933
Authors
Gargiulo G. Capodanno D. Sannino A. Perrino C. Capranzano P. Stabile E.
Trimarco B. Tamburino C. Esposito G.
Institution
(Gargiulo, Sannino, Capranzano, Stabile, Trimarco, Esposito) Division of
Cardiology, Department of Advanced Biomedical Sciences, Federico II
University of Naples, Via Pansini 5, Naples 80131, Italy
(Capodanno, Perrino, Tamburino) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Tamburino) Excellence Through Newest Advances (ETNA) Foundation, Catania,
Italy
Title
Moderate and severe preoperative chronic kidney disease worsen clinical
outcomes after transcatheter aortic valve implantation meta-analysis of
4992 patients.
Source
Circulation: Cardiovascular Interventions. 8 (2) , 2015. Article Number:
e002220. Date of Publication: 01 Feb 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-There is a conflicting evidence on safety and efficacy of
transcatheter aortic valve implantation in patients with preoperative
chronic kidney disease (CKD). Therefore, we conducted a meta-analysis on
the impact of CKD on outcomes after transcatheter aortic valve
implantation. Methods and Results-Nine studies including 4992 patients
were analyzed. Overall preoperative CKD (stages 3-5) significantly
increased early (odds ratio [OR], 1.44; 95% confidence interval [CI],
1.08-1.94 and OR, 1.66; 95% CI, 1.04-2.67) and 1-year (OR, 1.66; 95% CI,
1.23-2.25 and OR, 1.32; 95% CI, 1.06-1.63) all-cause and cardiovascular
mortality, respectively. Moderate CKD (stage 3) alone also increased early
and 1-year all-cause mortality (OR, 1.43; 95% CI, 1.10-1.85 and OR, 1.41;
95% CI, 1.13-1.74). CKD stages 4 to 5 and 3 compared with stages 1 to 2
increased early stroke (OR, 2.67; 95% CI, 1.53-4.65 and OR, 1.66; 95% CI,
1.09-2.52), acute kidney injury (OR, 2.09; 95% CI, 1.17-3.72 and OR, 1.32;
95% CI, 1.09-1.60) and need for dialysis (OR, 5.92; 95% CI, 2.46-14.27 and
OR, 1.55; 95% CI, 0.65-3.70), in the absence of significant differences in
contrast medium administration (mean difference, -26.07; 95% CI, -53.00 to
0.85 and mean difference, -0.42; 95% CI, -16.10 to 15.26). Bleeding
(life-threatening or major) was nonsignificantly increased in CKD 3 to 5
compared with CKD 1 to 2, but significantly increased in most severe
patients (CKD 4-5 versus CKD 1-2: OR, 1.66; 95% CI, 1.13-2.44; CKD 4-5
versus CKD 3: OR, 1.68; 95% CI, 1.27-2.24). Conclusions-Both moderate and
severe preoperative CKD significantly worsen transcatheter aortic valve
implantation prognosis. Future studies on risk evaluation, prevention, and
postoperative management are needed.

<16>
[Use Link to view the full text]
Accession Number
2015874928
Authors
Grundeken M.J. Li X. Kurpershoek C.E. Kramer M.C. Vink A. Piek J.J.
Tijssen J.G.P. Koch K.T. Wykrzykowska J.J. De Winter R.J. Van Der Wal A.C.
Institution
(Grundeken, Kramer, Piek, Tijssen, Koch, Wykrzykowska, De Winter)
Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Li, Kurpershoek, Van Der Wal) Department of Pathology, Academic Medical
Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105AZ,
Netherlands
(Vink) Department of Pathology, University Medical Center Utrecht,
Utrecht, Netherlands
Title
Distal embolization of hydrophilic-coating material from Coronary
guidewires after percutaneous coronary interventions.
Source
Circulation: Cardiovascular Interventions. 8 (2) , 2015. Article Number:
e001816. Date of Publication: 01 Feb 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-Coronary guidewires are indispensable during percutaneous
coronary interventions. Nowadays, most guidewires have hydrophilic
coatings to improve their trackability, allowing easy lesion passage and
facilitating balloon and stent positioning. Recent reports, however, have
raised concerns about detachment and subsequent embolization of these
hydrophilic coatings. Methods and Results-We have retrospectively reviewed
the histological samples of the myocardium, obtained during autopsies in
the period 2009 to 2013, from all patients who had a history of
percutaneous coronary interventions (n=40). Foreign material was observed
in the distal myocardium in 4 patients (10%). Furthermore, we have
reviewed 205 thrombus specimens which were obtained during thrombus
aspiration in the setting of primary percutaneous coronary interventions
in the period 2005 to 2009. In 45% of the cases, foreign material was
observed within the thrombus. Finally, we have examined the
histopathologic appearance of hydrophilic-guidewire coating material ex
vivo by embedding the coating in placenta specimen and cut and stain it in
exactly the same manner as the myocardium and thrombus specimen. The
histopathologic appearance of the hydrophilic coating ex vivo was
identical to the foreign material found in vivo. Conclusions-Distal
embolization of hydrophilic-coating material was observed in 10% of the
patients who had a history of percutaneous coronary interventions.
Hydrophilic-coating material was found in 45% of coronary thrombus
specimen obtained during thrombus aspiration. These findings suggest that
detachment and distal embolization of hydrophilic-coating material from
coronary guidewires occur more often than the sparse literature on this
topic suggests.

<17>
Accession Number
2015892861
Authors
Ai Z. Li L. Zheng X. Jie L.
Institution
(Li) Department of Science and Research, Taihe Hospital, Hubei University
of Medicine, Shiyan, Hubei Province 442000, China
(Ai) Department of Neurology, Taihe Hospital, Hubei University of
Medicine, Shiyan, Hubei Province 442000, China
(Li) Department of O and G, Shiyan Hospital of Traditional Chinese
Medicine, Shiyan, Hubei Province 442000, China
(Zheng) Department of Endocrine, Taihe Hospital, Hubei University of
Medicine, Shiyan, Hubei Province 442000, China
(Jie) Department of President's Office, Shiyan Hospital of Traditional
Chinese Medicine, No. 32, South of People Road, Shiyan, Hubei Province
442000, China
Title
Can routine oral care with antiseptics prevent ventilator-associated
pneumonia in patients receiving mechanical ventilation? An update
meta-analysis from 17 randomized controlled trials.
Source
International Journal of Clinical and Experimental Medicine. 8 (2) (pp
1645-1657), 2015. Date of Publication: 28 Feb 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: Whether oral antiseptics could reduce the risk of ventilator
associated pneumonia (VAP) in patients receiving mechanical ventilation
remains controversial. We performed a meta-analysis to assess the effect
of oral care with antiseptics on the prevalence of ventilator associated
pneumonia in adult critically ill patients. Methods: A comprehensive
search of PubMed, Embase and Web of Science were performed to identity
relevant studies. Eligible studies were randomized controlled trials of
mechanically ventilated adult patients receiving oral care with
antiseptics. The quality of included studies was assessed by the Jadad
score. Relative risks (RRs), weighted mean differences (WMDs), and 95%
confidence intervals (CIs) were calculated and pooled using a
fixed-effects model or random-effects model. Heterogeneity among the
studies was assessed with I2 test. Results: 17 studies with a total number
of 4249 met the inclusion criteria. Of the 17 studies, 14 assessed the
effect of chlorhexidine, and 3 investigated the effect of povidone-iodine.
Overall, oral care with antiseptics significantly reduced the prevalence
of VAP (RR=0.72, 95% CI: 0.57, 0.92; P=0.008). The use of chlorhexidine
was shown to be effective (RR=0.73, 95% CI: 0.57, 0.93; P=0.012), whereas
this effect was not observed in povidone-iodine (RR=0.51, 95% CI: 0.09,
2.82; P=0.438). Subgroup analyses showed that oral antiseptics were most
marked in cardiac surgery patients (RR=0.54, 95% CI: 0.39, 0.74; P=0.00).
Patients with oral antiseptics did not have a reduction in intensive care
unit (ICU) mortality (RR=1.11, 95% CI: 0.95, 1.29; P=0.201), length of ICU
stay (WMD=-0.10 days, 95% CI: -0.25, 0.05; P=0.188), or duration of
mechanical ventilation (WMD=-0.05 days, 95% CI: -0.14, 0.04; P=0.260).
Conclusion: Oral care with antiseptics significantly reduced the
prevalence of VAP. Chlorhexidine application prevented the occurrence of
VAP in mechanically ventilated patients but povidone-iodine did not.
Further large-scale, well-designed randomized controlled trials are needed
to identify the findings and determine the effect of povidone-iodine
application.

<18>
Accession Number
2015884744
Authors
Wang J. Gu C. Gao M. Yu W. Yu Y.
Institution
(Wang, Gu, Gao, Yu, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Preoperative statin therapy is associated with reduced 30-day
postoperative all-cause mortality in patients undergoing coronary artery
bypass surgery: A meta-analysis of large size observational studies.
Source
International Journal of Cardiology. 181 (pp 11-13), 2015. Date of
Publication: 15 Feb 2015.
Publisher
Elsevier Ireland Ltd

<19>
Accession Number
2015884764
Authors
Bulluck H. Kwok C.S. Ryding A.D. Loke Y.K.
Institution
(Bulluck) Hatter Cardiovascular Institute, University College London,
London WC1E 6HX, United Kingdom
(Kwok) Institute of Cardiovascular Sciences, University of Manchester,
Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
(Ryding, Loke) Norfolk and Norwich University Hospital, Colney Lane,
Norwich NR4 7UY, United Kingdom
(Loke) Norwich Medical School, University of East Anglia, Norwich Research
Park, Norwich NR4 7TJ, United Kingdom
Title
Safety of short-term dual antiplatelet therapy after drug-eluting stents:
An updated meta-analysis with direct and adjusted indirect comparison of
randomized control trials.
Source
International Journal of Cardiology. 181 (pp 331-339), 2015. Date of
Publication: 15 Feb 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background Duration of dual antiplatelet therapy (DAPT) following
drug-eluting stents (DES) remains controversial and is a topic of ongoing
research. Methods Direct and adjusted indirect comparisons of all the
recent randomized control trials (RCTs) were performed to evaluate the
safety of short-term versus long-term DAPT following DES. Results 8 RCTs
were identified and 7 (16,318 subjects) were included. 4 groups of 3 vs 12
months, 6 vs 12 months, 6 vs 24 months and 12 vs 24 months of DAPT were
used for direct comparison. There was no significant difference in stent
thrombosis, myocardial infarction (MI), stroke and revascularization,
cardiovascular and all-cause mortality between the different durations in
all 4 groups. Pooling trials of 3-6 months of DAPT against 12 months, we
found a significant reduction in the risk of total bleeding (RR 0.61, 95%
CI 0.43-0.87). Adjusted indirect comparison between 3 vs 6 months, 3 vs 24
months and 6 vs 24 month duration of DAPT showed no significant
differences in risk of death or MI, or revascularization between 3 or 6
months and 24 months. However, 24 months of DAPT was associated with
significantly more bleeding than 3 or 6 months. Conclusions 3 to 6 months
of DAPT following second generation DES and above is safe with no
increased risk of thrombotic complications and mortality, and lower
bleeding risk. However a tailored approach may be more appropriate for
high-risk patients.

<20>
Accession Number
2015884759
Authors
Taha S. Moretti C. D'Ascenzo F. Van Mieghem N.M. Omede P. Montefusco A.
Ghany M.A. Fouaad D. Demitry S. Zoccai G.B. Gaita F.
Institution
(Taha, Moretti, D'Ascenzo, Omede, Montefusco, Gaita) Citta della Salute e
della Scienza Hospital, Division of Cardiology 1, University of Turin,
Corso Bramante 88, Torino 10126, Italy
(Zoccai) Division of Cardiology, Rome, Italy
(Taha, Ghany, Fouaad, Demitry) Assuit University Hospital, Egypt
(Van Mieghem) Department of Interventional Cardiology Thoraxcenter,
Erasmus Medical Center, Rotterdam, Netherlands
(Taha) Cardiology Department, Assuit University, Egypt
Title
Impact of residual coronary artery disease on patients undergoing TAVI: A
meta-analysis of adjusted observational studies.
Source
International Journal of Cardiology. 181 (pp 77-80), 2015. Date of
Publication: 15 Feb 2015.
Publisher
Elsevier Ireland Ltd

<21>
Accession Number
2015764922
Authors
Fotso Kamdem A. Nerich V. Auber F. Jantchou P. Ecarnot F. Woronoff-Lemsi
M.-C.
Institution
(Fotso Kamdem, Auber) UMR-INSERM-1098, Department of Pediatric Surgery,
Besancon University Hospital, 3 Boulevard Fleming, Besancon F-25000,
France
(Nerich) INSERM U645 EA-2284 IFR-133, Department of Pharmacy, Besancon
University Hospital, 3 Boulevard Fleming, Besancon F-25000, France
(Jantchou) Division of Pediatric Gastroenterology, Hepatology and
Nutrition, Sainte-Justine University Hospital, 3175, Chemin de la Cote
Sainte-Catherine, Montreal, QC H3T 1C5, Canada
(Ecarnot) EA3920, Department of Cardiology, Besancon University Hospital,
3 Boulevard Fleming, Besancon F-25000, France
(Woronoff-Lemsi) UMR-INSERM-1098, Department of Clinical Research and
Innovation, Besancon University Hospital, 2 place Saint Jacques, Besancon
F-25000, France
Title
Quality assessment of economic evaluation studies in pediatric surgery: A
systematic review.
Source
Journal of Pediatric Surgery. 50 (4) (pp 659-687), 2015. Date of
Publication: 01 Apr 2015.
Publisher
W.B. Saunders
Abstract
Purpose To assess economic evaluation studies (EES) in pediatric surgery
and to identify potential factors associated with high-quality studies.
Methods A systematic review of the literature using PubMed and Cochrane
databases was conducted to identify EES in pediatric surgery published
between 1 June 1993 and 30 June 2013. Assessment criteria are derived from
the Drummond checklist. A high quality study was defined as a Drummond
score > 7. Logistic regression analysis was used to determine factors
associated with high quality studies. Results 119 studies were included.
43.7% (n = 52) of studies were full EES. Cost-effectiveness analysis was
the most frequent (61.5%) type of full EES. Only 31.6% of studies had a
Drummond score > 7 and 73% of these were full EES. The factors associated
with high quality were identification of costs (OR: 14.08; 95% CI:
3.38-100; p < 0.001), estimation of utility value (OR: 8.13; 95% CI:
2.02-43.47; p = 0.005) and study funding (OR: 3.50; 95% CI: 1.27-10.10; p
= 0.02). Conclusion This review shows that the number and the quality of
EES are low despite the increasing number of studies published in recent
years. In the current context of budget constraints, our results should
encourage pediatric surgeons to focus more on EES.

<22>
Accession Number
2015662716
Authors
Beer L. Warszawska J.M. Schenk P. Debreceni T. Dworschak M. Roth G.A.
Szerafin T. Ankersmit H.J.
Institution
(Beer, Ankersmit) Department of Thoracic Surgery, Medical University
Vienna, Wahringer Gurtel 18-20, Vienna A-1090, Austria
(Beer, Ankersmit) Christian Doppler Laboratory for Cardiac and Thoracic
Diagnosis and Regeneration, Wahringer Gurtel 18-20, Vienna A-1090, Austria
(Warszawska, Dworschak, Roth) Department of Anesthesia, General Intensive
Care and Pain Management, Medical University of Vienna, Vienna, Austria
(Schenk) Department of Pulmonology, Landesklinikum Thermenregion Hochegg,
Grimmenstein, Austria
(Debreceni, Szerafin) Department of Cardiac Surgery, Institute of
Cardiology, Medical- and Health Science Centre of University of Debrecen,
Debrecen, Hungary
Title
Intraoperative ventilation strategy during cardiopulmonary bypass
attenuates the release of matrix metalloproteinases and improves
oxygenation.
Source
Journal of Surgical Research. 195 (1) (pp 294-302), 2015. Date of
Publication: 01 May 2015.
Publisher
Academic Press Inc.
Abstract
Background Patients undergoing open heart surgery with cardiopulmonary
bypass (CPB) often develop a systemic immune reaction, characterized by an
increase of proinflammatory and anti-inflammatory mediators. We previously
demonstrated that continued mechanical ventilation during CPB reduces this
response. We hypothesized that this strategy may also impact on matrix
metalloproteinase (MMP) release. Material and methods Thirty consecutive
patients undergoing coronary artery bypass grafting with CPB were
randomized into a ventilated (VG) (n = 15) and a standard non-ventilated
group (NVG) (n = 15). Blood was collected at the beginning, at the end of
surgery, and on the five consecutive days. MMPs, tissue inhibitor of
matrix metalloproteinase 1 (TIMP-1), and lipocalin 2 (LCN2) were measured
by enzyme-linked immunosorbent assay. Parameters of transpulmonary oxygen
transport were assessed at different time points. Results MMP-8, MMP-9,
and LCN2 were significantly lower at the end of surgery in VG compared
with those in NVG patients (MMP-8 [ng/mL]: 7.1 [3.5] versus 12.5 [7.7], P
= 0.02; MMP-9 [ng/mL]: 108 [42] versus 171 [98], P = 0.029; LCN2 [ng/mL]:
109 [42] versus 171 [98], P = 0.03). TIMP-1 concentrations were lower on
postoperative day one, (TIMP-1 [ng/mL]: 174 [55] versus 273 [104], P =
0.003), whereas MMP-3 levels were lower on postoperative days four and
five (MMP-3 [ng/mL]: 44 [17] versus 67 [35], P = 0.026). The arterial
partial pressure of oxygen/fraction of inspired oxygen ratio was
significantly higher in VG patients throughout the postoperative
observation period, which did not affect the length of postoperative
ventilatory support. Conclusions Continued mechanical ventilation during
CPB reduces serum levels of MMPs, their inhibitor TIMP-1 and LCN2, which
preserves MMP-9 activity. The present study suggests that continued
mechanical ventilation improves postoperative oxygenation and could
potentially prevent aggravation of lung injury after CPB.

<23>
Accession Number
2015898773
Authors
Mistiaen W.P.
Institution
(Mistiaen) University of Antwerp, Dept. of Healthcare Sciences,
Artesis-Plantijn University College of Antwerp, Antwerp, Belgium
Title
Heart transplantation in patients with previous malignancy. An overview.
Source
Acta Cardiologica. 70 (2) (pp 123-130), 2015. Date of Publication: 2015.
Publisher
Acta Cardiologica (Weldadigheidsstraat 49, Leuven B-3000, Belgium)
Abstract
Introduction A history of malignancy has been considered as a
contraindication for heart transplantation. The number of patients with
prior malignancy needing transplantation is increasing due to improved
survival and to cardiotoxic cancer treatment. However, this reluctance for
transplantation can be challenged by the already available results.
Methods A systematic literature search was performed in electronic
databases. After exclusion of cardiac sarcomas, three case reports,
thirteen series of which three are paediatric, two database searches and
one article with specific design have been found. The larger series are of
more recent origin. The study design of the manuscripts differed to some
degree. Results The preoperative profi le and the postoperative results
are reviewed. The preoperative profi le includes demographics, interval
between treatment of malignancy and transplantation, indication of
transplantation and differences between patients with and without prior
malignancy. An important observation is the increase of transplantation in
patients with chemotherapy-related cardiomyopathy over time. The
postoperative results show that hospital mortality and long-term survival
do not differ signifi cantly between patients with and without
pre-transplant malignancy. This seems also to be true for post-transplant
recurrence. The disease-free pre-transplant interval has a major effect on
both outcomes. Patients with haematologic malignancies and after
splenectomy have a worse prognosis. Use of LVAD (left ventricular assist
device) as bridge-to-transplant and rapamycin as immune suppression, holds
some promises. Conclusions This review has some limitations since the
published series are not comparable. It seems that transplantation in
patients with prior malignancy can be justified in some cases, especially
when the interval between malignancy and transplantation exceeds five
years.

<24>
Accession Number
2015878988
Authors
Deliva R.D. Patterson C. So S. Pellow V. Miske S. McLister C. Manlhiot C.
Pollock-BarZiv S. Drabble A. Dipchand A.I.
Institution
(Deliva, Patterson, So, Pellow, Miske, McLister) Division of
Physiotherapy, Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada
(Deliva, Patterson, So, Pollock-BarZiv, Drabble, Dipchand) SickKids
Transplant Centre, Hospital for Sick Children, University of Toronto,
Toronto, ON, Canada
(Manlhiot, Drabble, Dipchand) Labatt Family Heart Centre, Hospital for
Sick Children, University of Toronto, Toronto, ON, Canada
(Deliva) Department of Rehabilitation Services, Hospital for Sick
Children, 555 University Ave., Toronto, ON M5G 1X8, Canada
Title
The World Transplant Games: An incentive to improve physical fitness and
habitual activity in pediatric solid organ transplant recipients.
Source
Pediatric Transplantation. 18 (8) (pp 889-895), 2014. Date of Publication:
2014.
Publisher
Blackwell Publishing Inc.
Abstract
This prospective, interventional study examined the impact of training for
the WTG on levels of health-related physical fitness and habitual activity
in a cohort of pediatric SOT recipients. Physical fitness (FitnessGram)
and habitual activity (HAES) measures were performed on participants (n =
19) in the WTG and compared to nonparticipant controls (n = 14) prior to
and following the WTG. Pre-WTG exercise training was provided to
participants. Participants demonstrated a statistically significant
improvement in their habitual weekday (6.1 +/- 1.7 to 8.5 +/- 1.9 h; p =
0.002) and weekend (6.3 +/- 2.6 to 8.4 +/- 2.5 h; p = 0.01) activity over
the training period, while controls improved weekday activity only (6.3
+/- 2.0 to 8.3 +/-2.1 h; p = 0.05. Weekend activity: 7.7 +/- 2.7 to 8.3
+/- 2.3 h; p = 0.68). Participants demonstrated a non-statistical
improvement in select physical fitness parameters; however, a greater
number of participants achieved healthy criterion standards for
cardiovascular fitness (2 vs. 1), abdominal strength (5 vs. 3), and upper
body strength (7 vs. 3) following training and participating in the WTG.
The WTG can provide a positive incentive for greater levels of physical
activity and promote improvements in physical fitness levels. Further
study is needed to examine long-term impact on lifestyle changes and
health outcomes.

<25>
Accession Number
2015873782
Authors
McCrindle B.W. Clarizia N.A. Khaikin S. Holtby H.M. Manlhiot C. Schwartz
S.M. Caldarone C.A. Coles J.G. Van Arsdell G.S. Scherer S.W. Redington
A.N.
Institution
(McCrindle, Clarizia, Khaikin, Holtby, Manlhiot, Schwartz, Caldarone,
Coles, Van Arsdell, Redington) Labatt Family Heart Centre, The Hospital
for Sick Children, Toronto, ON, Canada
(Scherer) The Centre for Applied Genomics, The Hospital for Sick Children,
Toronto, ON, Canada
(McCrindle, Redington) Department of Pediatrics, University of Toronto,
Toronto, ON, Canada
(Holtby) Department of Anesthesiology, University of Toronto, Toronto, ON,
Canada
(Schwartz) Department of Critical Care Medicine, University of Toronto,
Toronto, ON, Canada
(Caldarone, Coles, Van Arsdell) Department of Surgery, University of
Toronto, Toronto, ON, Canada
(Scherer) The McLaughlin Centre, University of Toronto, Toronto, ON,
Canada
Title
Remote ischemic preconditioning in children undergoing cardiac surgery
with cardiopulmonary bypass: A single-center double-blinded randomized
trial.
Source
Journal of the American Heart Association. 3 (4) , 2014. Article Number:
e000964. Date of Publication: 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Remote ischemic preconditioning (RIPC) harnesses an innate
defensive mechanism that protects against inflammatory activation and
ischemia-reperfusion injury, known sequelae of cardiac surgery with
cardiopulmonary bypass. We sought to determine the impact of RIPC on
clinical outcomes and physiological markers related to
ischemia-reperfusion injury and inflammatory activation after cardiac
surgery in children. Methods and Results: Overall, 299 children (aged
neonate to 17 years) were randomized to receive an RIPC stimulus
(inflation of a blood pressure cuff on the left thigh to 15 mm Hg above
systolic for four 5-minute intervals) versus a blinded sham stimulus
during induction with a standardized anesthesia protocol. Primary outcome
was duration of postoperative hospital stay, with serial clinical and
laboratory measurements for the first 48 postoperative hours and clinical
follow-up to discharge. There were no significant baseline differences
between RIPC (n=148) and sham (n=151). There were no in-hospital deaths.
No significant difference in length of postoperative hospital stay was
noted (sham 5.4 versus RIPC 5.6 days; difference +0.2; adjusted P=0.91),
with the 95% confidence interval (-0.7 to +0.9) excluding a prespecified
minimal clinically significant differences of 1 or 1.5 days. There were
few significant differences in other clinical outcomes or values at time
points or trends in physiological markers. Benefit was not observed in
specific subgroups when explored through interactions with categories of
age, sex, surgery type, Aristotle score, or first versus second half of
recruitment. Adverse events were similar (sham 5%, RIPC 6%; P=0.68).
Conclusions: RIPC is not associated with important improvements in
clinical outcomes and physiological markers after cardiac surgery in
children.

<26>
Accession Number
2015873438
Authors
Patel N.N. Angelini G.D.
Institution
(Patel, Angelini) Bristol Heart Institute, University of Bristol, Bristol
Royal Infirmary, Bristol BS2 8HW, United Kingdom
(Patel, Angelini) National Heart and Lung Institute, Imperial College
London, Hammersmith Hospital, London W12 0HS, United Kingdom
Title
Pharmacological strategies for the prevention of acute kidney injury
following cardiac surgery: An overview of systematic reviews.
Source
Current Pharmaceutical Design. 20 (34) (pp 5484-5488), 2014. Date of
Publication: 01 Jan 2014.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Context: Post cardiac surgery acute kidney injury (AKI) is common, poorly
understood and associated with a significant increase in morbidity and
mortality. Objectives: An overview of systematic reviews that have
evaluated pharmacological agents for the prevention of AKI post cardiac
surgery. Data Sources: We searched electronic databases (PubMed and the
Cochrane Database of Systematic Reviews) from inception to January 2014.
Study Selection: Systematic reviews of randomized controlled trials that
have evaluated pharmacological agents for the prevention of AKI in adult
patients undergoing cardiac surgery. Data Analysis: Numbers needed to
treat (NNT) or harm (NNH) were calculated from pooled events given in each
meta-analysis. Primary outcome measures were defined as (i) mortality,
(ii) need for renal replacement therapy (RRT), and (iii) acute kidney
injury. Results: Data from 7 systematic reviews evaluating 6 different
pharmacological renoprotective agents were included. Dopamine, fenoldopam
and N-acetylcysteine did not demonstrate any benefit in terms of
mortality, need for RRT or incidence of AKI. Atrial natriuretic peptide
reduced the need for RRT (NNT = 22 (95% CI: 13 to 73) and brain
natriuretic peptide reduced the incidence of AKI (NNT = 11 (95% CI: 6 to
32), although both agents did not demonstrate any effect on mortality.
Loop diuretics demonstrated increased incidence of AKI (NNH = 8 (95% CI: 5
to 15). Conclusion: There is a paucity of effective renoprotective agents
that can be used in adult cardiac surgical patients. There is an urgent
need to develop novel renoprotective strategies.

<27>
Accession Number
2015872078
Authors
Zhang S. Wu X. Guo H. Ma L.
Institution
(Zhang, Guo, Ma) Department of Anesthesiology, General Hospital of Beijing
Military Region PLA, Beijing 100010, China
(Wu) Department of Anesthesiology, First Hospital, Peking University,
Beijing 100034, China
Title
Thoracic epidural anesthesia improves outcomes in patients undergoing
cardiac surgery: Meta-analysis of randomized controlled trials.
Source
European Journal of Medical Research. 20 (1) , 2015. Article Number: 25.
Date of Publication: 2015.
Publisher
BioMed Central Ltd.
Abstract
To assess the efficacy of thoracic epidural anesthesia (TEA) with or
without general anesthesia (GA) versus GA in patients who underwent
cardiac surgery, PubMed, Embase, the Cochrane online database, and Web of
Science were searched with the limit of randomized controlled trials
(RCTs) relevant to 'thoracic epidural anesthesia' and 'cardiac surgery'.
Studies were identified and data were extracted by two reviewers
independently. The quality of included studies was also assessed according
to the Cochrane handbook. Outcomes of mortality, cardiac and respiratory
functions, and treatment-associated complications were pooled and
analyzed. The comprehensive search yielded 2,230 citations, and 25 of them
enrolling 3,062 participants were included according to the inclusion
criteria. Compared with GA alone, patients received TEA and GA showed
reduced risks of death, myocardial infarction, and stroke, though there
were no significant differences (P>0.05). With regard to treatment-related
complications, the pooled results for respiratory complications (risk
ratio (RR), 0.69; 95% CI: 0.51, 0.91, P<0.05), supraventricular
arrhythmias (RR, 0.61; 95% CI: 0.42, 0.87, P<0.05), and pain (mean
difference (MD), -1.27; 95% CI: -2.20, -0.35, P<0.05) were 0.69, 0.61, and
-1.27, respectively. TEA was also associated with significant reduction of
stays in intensive care unit (MD, -2.36; 95% CI: -4.20, -0.52, P<0.05) and
hospital (MD, -1.51; 95% CI: -3.03, 0.02, P>0.05) and time to tracheal
extubation (MD, -2.06; 95% CI:-2.68, -1.45, P<0.05). TEA could reduce the
risk of complications such as supraventricular arrhythmias, stays in
hospital or intensive care unit, and time to tracheal extubation in
patients who experienced cardiac surgery.

<28>
[Use Link to view the full text]
Accession Number
2015872514
Authors
Rodes-Cabau J. Pibarot P. Suri R.M. Kodali S. Thourani V.H. Szeto W.Y.
Svensson L.G. Dumont E. Xu K. Hahn R.T. Leon M.B.
Institution
(Rodes-Cabau, Pibarot, Dumont) Quebec Heart and Lung Institute, Laval
University, 2725 Chemin Ste-Foy, Quebec City, QC G1V 4G5, Canada
(Suri) Mayo Clinic, Rochester, MN, United States
(Kodali, Hahn, Leon) Columbia University Medical Center, NewYork
Presbyterian Hospital, New York, NY, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Szeto) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Svensson) Cleveland Clinic, Cleveland, OH, United States
(Xu) Cardiovascular Research Foundation, New York, NY, United States
Title
Impact of aortic annulus size on valve hemodynamics and clinical outcomes
after transcatheter and surgical aortic valve replacement insights from
the PARTNER trial.
Source
Circulation: Cardiovascular Interventions. 7 (5) (pp 701-711), 2014. Date
of Publication: 01 Oct 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The objective was to evaluate the effects of aortic annulus
size on valve hemodynamics and clinical outcomes in those patients
included in the Placement of Aortic Transcatheter Valves (PARTNER)
randomized controlled trial cohort A and the nonrandomized continued
access cohort.Methods and Results: Patients included the randomized
controlled trial (n=574) and nonrandomized continued access (n=1358)
cohorts were divided in tertiles according to aortic annulus diameter
(small aortic annulus tertile, medium aortic annulus tertile, and large
aortic annulus tertile [LAA], respectively) as measured by transthoracic
echocardiography. Severe prosthesis-patient mismatch was defined as an
effective aortic orifice area of <0.65 cm₂/m₂. In
the randomized controlled trial cohort, patients in the small aortic
annulus tertile who underwent transcatheter aortic valve replacement had a
lower incidence of severe prosthesis-patient mismatch (19.7% versus 37.5%;
P=0.03) and only a trend toward a higher incidence of moderate-to-severe
paravalvular leaks compared with surgical aortic valve replacement (5.7%
versus 0%; P=0.06). In the LAA tertile, there were no differences in the
rate of prosthesis-patient mismatch between groups, and a significant
increase in moderate-to-severe paravalvular leaks was associated with
transcatheter aortic valve replacement (9% versus 0%; P=0.01). There were
no differences in mortality between transcatheter aortic valve replacement
and surgical aortic valve replacement. In the nonrandomized continued
access cohort, there were no differences in prosthesis-patient mismatch
between the small aortic annulus and LAA tertiles, but a higher rate of
moderate-to-severe paravalvular leaks was observed in the LAA tertile
(5.9% versus 11.5%; P=0.009). Patients in the LAA tertile had a higher
mortality rate at 1-year follow-up (P=0.02), and differences persisted in
multivariable analysis (P=0.048 for LAA versus medium aortic annulus
tertile, P=0.035 for LAA versus small aortic annulus
tertile)..Conclusions-Aortic annulus size had a major impact on valve
hemodynamics and clinical outcomes after transcatheter aortic valve
replacement and surgical aortic valve replacement. This study highlights
the importance of considering aortic annulus size in the evaluation of
high-risk patients who are candidates for aortic valve replacement.
Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00530894..

<29>
[Use Link to view the full text]
Accession Number
2015872273
Authors
Arnold S.V. Lei Y. Reynolds M.R. Magnuson E.A. Suri R.M. Tuzcu E.M.
Petersen J.L. Douglas P.S. Svensson L.G. Gada H. Thourani V.H. Kodali S.K.
Mack M.J. Leon M.B. Cohen D.J.
Institution
(Arnold, Lei, Magnuson, Cohen) Saint Luke's Mid America Heart Institute,
4401 Wornall Rd, Kansas City, MO 64111, United States
(Arnold, Magnuson, Cohen) University of Missouri, Kansas City, United
States
(Reynolds) Harvard Clinical Research Institute, Boston, MA, United States
(Suri) Mayo Clinic, Rochester, MN, United States
(Tuzcu, Svensson) Cleveland Clinic Foundation, OH, United States
(Petersen) Swedish Medical Center, Seattle, WA, United States
(Douglas) Duke University, Durham, NC, United States
(Gada, Kodali, Leon) Columbia-Presbyterian Hospital, New York, NY, United
States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Mack) Baylor Healthcare System, Plano, TX, United States
Title
Costs of periprocedural complications in patients treated with
transcatheter aortic valve replacement: Results from the placement of
aortic transcatheter valve trial.
Source
Circulation: Cardiovascular Interventions. 7 (6) (pp 829-836), 2014. Date
of Publication: 01 Dec 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-In patients with severe aortic stenosis, transcatheter aortic
valve replacement (TAVR) improves survival when compared with nonsurgical
therapy but with higher in-hospital and lifetime costs. Complications
associated with TAVR may decrease with greater experience and improved
devices, thereby reducing the overall cost of the procedure. Therefore, we
sought to estimate the effect of periprocedural complications on
in-hospital costs and length of stay of TAVR. Methods and Results-Using
detailed cost data from 406 TAVR patients enrolled in the Placement of
Aortic Transcatheter Valve (PARTNER) I trial, we developed multivariable
models to estimate the incremental cost and length of stay associated with
specific periprocedural complications. Attributable costs and length of
stay for each complication were calculated by multiplying the independent
cost of each event by its frequency in the treatment group. Mean cost for
the initial hospitalization was $79 619+/-40 570 ($50 891 excluding the
valve); 49% of patients had =1 complication. Seven complications were
independently associated with increased hospital costs, with major
bleeding, arrhythmia, and death accounting for the largest attributable
cost per patient. Renal failure and the need for repeat TAVR, although
less frequent, were also associated with substantial incremental and
attributable costs. Overall, complications accounted for $12 475 per
patient in initial hospital costs and 2.4 days of hospitalization.
Conclusions-In the PARTNER trial, periprocedural complications were
frequent, costly, and accounted for =25% of nonimplant- related hospital
costs. Avoidance of complications should improve the cost-effectiveness of
TAVR for inoperable and high-risk patients, but reductions in the cost of
uncomplicated TAVR will also be necessary for optimal efficiency.

<30>
[Use Link to view the full text]
Accession Number
2015872265
Authors
Poerner T.C. Otto S. Gassdorf J. Nitsche K. Janiak F. Scheller B. Goebel
B. Jung C. Figulla H.R.
Institution
(Poerner, Otto, Gassdorf, Nitsche, Janiak, Goebel, Jung, Figulla) 1st
Department of Medicine, Division of Cardiology, University Hospital of
Jena, Jena, Germany
(Scheller) Clinical and Experimental Interventional Cardiology, Internal
Medicine III, University of Saarland, Saarbrucken, Germany
Title
Stent coverage and neointimal proliferation in bare metal stents
postdilated with a paclitaxel-eluting balloon versus everolimus-eluting
stents: Prospective randomized study using optical coherence tomography at
6-month follow-up.
Source
Circulation: Cardiovascular Interventions. 7 (6) (pp 760-767), 2014. Date
of Publication: 01 Dec 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-In this randomized trial, strut coverage and neointimal
proliferation of a therapy of bare metal stents (BMSs) postdilated with
the paclitaxel drug-eluting balloon (DEB) was compared with everolimus
drug-eluting stents (DESs) at 6-month follow-up using optical coherence
tomography. We hypothesized sufficient stent coverage at follow-up.
Methods and Results-A total of 105 lesions in 90 patients were treated
with either XIENCE V DES (n=51) or BMS postdilated with the SeQuent Please
DEB (n=54). At follow-up, comparable results on the primary optical
coherence tomography end point (percentage uncovered struts 5.64+/-9.65%
in BMS+DEB versus 4.93+/-9.29% in DES; P=0.366) were found. Thus, BMS+DEB
achieved the prespecified noninferiority margin of 5% uncovered struts
versus DES (difference between treatment means, 0.71%; one-sided upper 95%
confidence interval, 4.14%; noninferiority P=0.04). Optical coherence
tomography analysis showed significantly more global neointimal
proliferation in the BMS+DEB group (15.7+/-7.8 versus 11.0+/-5.2 mm3
proliferation volume/cm stent length; P=0.002). No significant focal
in-stent stenosis analyzed with angiography (percentage diameter stenosis
at follow-up, 22.8+/-11.9 versus 16.9+/-10.4; P=0.014) and optical
coherence tomography (peak local area stenosis, 39.5+/-13.8% versus
36.8+/-15.6%; P=0.409) was found. Conclusions-Good stent strut coverage of
>94% was found in both therapy groups. Despite greater suppression of
global neointimal growth in DES, both DES and BMS+DEB effectively
prevented clinically relevant focal restenosis at 6-month follow-up.

<31>
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Accession Number
2015872239
Authors
Mark D.B. Anstrom K.J. Clapp-Channing N.E. Knight J.D. Boineau R. Goertz
C. Rozema T.C. Liu D.M. Nahin R.L. Rosenberg Y. Drisko J. Lee K.L. Lamas
G.A.
Institution
(Mark, Anstrom, Clapp-Channing, Knight, Liu) Outcomes Research Group, Duke
University Medical Center, Duke University, 2400 Pratt St, Durham, NC
27705, United States
(Lee) Duke Clinical Research Institute, Duke University Medical Center,
Duke University, Durham, NC, United States
(Boineau, Nahin, Rosenberg) National Heart, Lung, and Blood Institute,
Bethesda, MD, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Rozema) Biogenesis Medical Center, Landrum, SC, United States
(Drisko) Integrative Medicine, University of Kansas Medical Center, Kansas
City, United States
(Lamas) Columbia University Division of Cardiology, Mount Sinai Medical
Center, Miami, FL, United States
Title
Quality-of-life outcomes with a disodium EDTA chelation regimen for
coronary disease: Results from the trial to assess chelation therapy
randomized trial.
Source
Circulation: Cardiovascular Quality and Outcomes. 7 (4) (pp 508-516),
2014. Date of Publication: 01 Jul 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Background-The National Institutes of Health-funded Trial to Assess
Chelation Therapy (TACT) randomized 1708 stable coronary disease patients
aged =50 years who were =6 months post-myocardial infarction (2003-2010)
to 40 infusions of a multicomponent EDTA chelation solution or placebo.
Chelation reduced the primary composite end point of mortality, recurrent
myocardial infarction, stroke, coronary revascularization, or
hospitalization for angina (hazard ratio, 0.82; 95% confidence interval,
0.69-0.99; P=0.035). Methods and Results-In a randomly selected subset of
911 patients, we prospectively collected a battery of quality-of-life
(QOL) instruments at baseline and at 6, 12, and 24 months after
randomization. The prespecified primary QOL measures were the Duke
Activity Status Index (Table I in the Data Supplement) and the Medical
Outcomes Study Short-Form 36 Mental Health Inventory-5. All comparisons
were by intention to treat. Baseline clinical and QOL variables were well
balanced in the 451 patients randomized to chelation and in the 460
patients randomized to placebo. The Duke Activity Status Index improved in
both groups during the first 6 months of therapy, but we found no evidence
for a treatment-related difference (mean difference [chelation-placebo]
during follow-up, 0.9 [95% confidence interval, -0.7 to 2.6; P=0.27]).
There was no statistically significant evidence of a treatment-related
difference in the Mental Health Inventory-5 during follow-up (mean
difference, 1.0; 95% confidence interval, -0.1 to 2.0; P=0.08). None of
the secondary QOL measures showed a consistent treatment-related
difference. Conclusions-In stable, predominantly asymptomatic coronary
disease patients with a history of myocardial infarction, EDTA chelation
therapy did not have a detectable effect on QOL during 2 years of
follow-up.

<32>
[Use Link to view the full text]
Accession Number
2014739457
Authors
Turkoz A. Tuncay E. Balci S.T. Can M.G. Altun D. Turkoz R. Undar A.
Institution
(Turkoz, Tuncay, Balci, Can, Altun) Department of Anesthesiology, Baskent
University Istanbul, Teaching and Medical Research Center, Istanbul,
Turkey
(Turkoz) Department of Cardiovascular Surgery, Baskent University
Istanbul, Teaching and Medical Research Center, Istanbul, Turkey
(Undar) Department of Pediatrics, Surgery and Bioengineering, Penn State
Hershey College of Medicine, Pediatric Cardiovascular Research Center,
Hershey, PA, United States
Title
The effect of modified ultrafiltration duration on pulmonary functions and
hemodynamics in newborns and infants following arterial switch operation.
Source
Pediatric Critical Care Medicine. 15 (7) (pp 600-607), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Modified ultrafiltration is used to ameliorate the deleterious
effects of cardiopulmonary bypass in pediatric cardiac surgery patients.
The ideal duration of modified ultrafiltration has not been established
yet. We investigated the effects of extended duration of modified
ultrafiltration on pulmonary functions and hemodynamics in the early
postoperative period in newborns and infants who had transposition of
great arteries operations. Design: Single-center prospective randomized
study. Setting: Pediatric cardiac surgery operating room and ICU.
Patients: Sixty newborns and infants who had been scheduled to undergo
transposition of great arteries operation. Interventions: None.
Measurements and Main Results: Modified ultrafiltration was applied to all
patients following the termination of cardiopulmonary bypass (for 10, 15,
and 20min in groups 1, 2, and 3, respectively). Pulmonary compliance, gas
exchange capacity, hemodynamic measurements, inotropic support, blood
loss, transfusion requirements, hematocrit level, and duration of
ventilatory support were measured after intubation, at termination of
cardiopulmonary bypass, at the end of modified ultrafiltration, and in the
1st, 6th, 12th, and 24th hours after admission to ICU. The amount of fluid
removed by modified ultrafiltration in groups 2 and 3 was larger than that
of group 1 (p < 0.01). Systolic blood pressure was significantly increased
at the end of modified ultrafiltration in group 3 compared to groups 1 and
2 (p < 0.05). Hematocrit levels were significantly increased at the end of
modified ultrafiltration in groups 2 and 3 compared to group 1 (p<0.01).
Therefore, RBCs were transfused less after modified ultrafiltration in
groups 2 and 3 compared to group 1 (p < 0.05). Static and dynamic
compliance, oxygen index, and ventilation index had improved similarly in
all three groups at the end of modified ultrafiltration (p > 0.05)
Conclusions: Modified ultrafiltration acutely improved pulmonary
compliance and gas exchange in all groups. Increased hematocrit and blood
pressure levels were also observed in the longer modified ultrafiltration
group. However, extended duration of modified ultrafiltration did not have
a significant impact on duration of intubation or the stay in ICU.

<33>
[Use Link to view the full text]
Accession Number
2015876424
Authors
Lu M. Sajobi T. Lucyk K. Lorenzetti D. Quan H.
Institution
(Lu) Department of Economics and Community Health Sciences, Centre for
Health and Policy Studies, University of Calgary, Calgary, AB, Canada
(Sajobi, Lucyk, Lorenzetti, Quan) Department of Community Health Sciences,
Centre for Health and Policy Studies, University of Calgary, Calgary, AB,
Canada
Title
Systematic review of risk adjustment models of hospital Length of Stay
(LOS).
Source
Medical Care. 53 (4) (pp 355-365), 2013. Date of Publication: 30 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Policy decisions in health care, such as hospital performance
evaluation and performance-based budgeting, require an accurate prediction
of hospital length of stay (LOS). This paper provides a systematic review
of risk adjustment models for hospital LOS, and focuses primarily on
studies that use administrative data. Methods: MEDLINE, EMBASE, Cochrane,
PubMed, and EconLit were searched for studies that tested the performance
of risk adjustment models in predicting hospital LOS. We included studies
that tested models developed for the general inpatient population, and
excluded those that analyzed risk factors only correlated with LOS, impact
analyses, or those that used disease-specific scales and indexes to
predict LOS. Results: Our search yielded 3973 abstracts, of which 37 were
included. These studies used various disease groupers and severity/
morbidity indexes to predict LOS. Few models were developed specifically
for explaining hospital LOS; most focused primarily on explaining resource
spending and the costs associated with hospital LOS, and applied these
models to hospital LOS. We found a large variation in predictive power
across different LOS predictive models. The best model performance for
most studies fell in the range of 0.30-0.60, approximately. Conclusions:
The current risk adjustment methodologies for predicting LOS are still
limited in terms of models, predictors, and predictive power. One possible
approach to improving the performance of LOS risk adjustment models is to
include more diseasespecific variables, such as disease-specific or
condition-specific measures, and functional measures. For this approach,
however, more comprehensive and standardized data are urgently needed. In
addition, statistical methods and evaluation tools more appropriate to LOS
should be tested and adopted.

<34>
Accession Number
71835221
Title
64th Annual Scientific Session of the American College of Cardiology and
i2 Summit: Innovation in Intervention, ACC.15.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) , 2015. Date of Publication: 17 Mar 2015.
Publisher
Elsevier USA
Abstract
The proceedings contain 2162 papers. The topics discussed include:
myocardial injury during on-pump coronary artery bypass surgery;
mobilization of endothelial progenitor cells in acute cardiovascular
events: time-course after acute myocardial infarction and stroke;
standardized ST -elevation myocardial infarction protocol is associated
with comparable mortality in women and men; percutaneous coronary
intervention with half dose fibrinolysis versus primary percutaneous
coronary intervention in ST elevation myocardial infarction: evidence from
a meta-analysis; performance reports and the utilization of
guideline-based therapies in a large clinical trial population enrolled
after an acute coronary syndrome: insights from the SOLID -TIMI 52 trial;
and telomerase activity in older patients presenting with non-ST elevation
acute coronary syndrome.

<35>
Accession Number
71834989
Authors
Panchal H.B. Barry N. Bhatheja S. Ramu V. Paul T. Lavine S.
Institution
(Panchal, Barry, Bhatheja, Ramu, Paul, Lavine) East Tennessee State
University, Johnson City, TN, United States
Title
Requirement of permanent pacemaker placement and incidence of left bundle
branch block in patients undergoing transcatheter aoritc valve
implantation: A meta-analysis of edwards SAPIEN valve versus medtronic
core valve.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1933), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: The objective of this meta-analysis is to compare the
procedural complications requiring permanent pacemaker placement and
incidence of left bundle branch block in patients who underwent
transcatheter aortic valve implantation (TAVI) using Edwards SAPIEN valve
(EV) and Medtronic CoreValve (CV). Methods: PubMed and the Cochrane Center
Register of Controlled Trials were searched through September 2014. Twenty
two studies (n=7134) comparing TAVI procedure using EV (n=2741) and CV
(n=4393) were included. End points were procedural complications requiring
permanent pacemaker placement and incidence of left bundle branch block.
The odds ratio (OR) with 95% confidence interval (CI) was computed and
p<0.05 was considered as a level of significance. Results: Procedural
complications requiring permanent pacemaker placement were significantly
higher in CV group compared to EV group (OR: 3.98, CI: 3.35-4.74,
p<0.00001) (Figure). Incidence of left bundle branch block was
significantly higher in CV group compared to EV group (OR: 6.55, CI:
4.76-9.03, p<0.00001). Conclusion: The results of our meta-analysis of
7134 patients suggest that TAVI procedure using CV causes significantly
higher procedural complications requiring permanent pacemaker placement
and incidence of left bundle branch block compared to TAVI procedure using
EV. (Table presented) .

<36>
Accession Number
71834969
Authors
Matta A. Akinapelli A. Nagabandi A. Alla V. Delcore M.
Institution
(Matta, Akinapelli, Nagabandi, Alla, Delcore) Creighton University Medical
Center, Omaha, NE, United States
Title
A systematic review of percutaneous closure of ruptured sinus of valsalva
aneurysm in adults.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1913), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Sinus of Valsalva aneurysm (SVA) is a rare anomaly and is
mostly congenital. It can rupture into one of the cardiac chambers leading
to aorto-cardiac fistula. Urgent repair is recommended to prevent heart
failure. Surgical repair with patch closure has been the treatment of
choice. Percutaneous closure is a newer, less invasive alternative to open
surgery. We wanted to determine the success rate and mortality of
percutaneous closure of ruptured sinus of Valsalva aneurysm (RSVA) and to
identify the potential complications of the procedure. Methods: A
systematic search of Pubmed and Cochrane library were conducted. Key words
used in the search were "percutaneous closure" and "ruptured sinus of
Valsalva aneurysm". Case reports and case series published in English
involving patients above the age of 16 years were collected and compiled.
Results: The mean age of the patients undergoing percutaneous closure for
RSVA was 35.2 years (Range 16-74). Most of the aneurysms originated from
the right coronary sinus (59%). The most common site of rupture was the
right atrium (57%) followed by the right ventricle (40%). Shortness of
breath was the commonest symptoms at presentation. Most of the operators
(80%) preferred to use a PDA occluder to close the ruptured aneurysmal
tract. The occluders were successfully deployed in 96% (142/148) patients.
Of the people in whom the devices were successfully deployed, 15% (21/142)
had complications, most of which were managed medically. Almost all of the
patients who underwent a successful procedure had improvement in their
symptoms. Conclusion: Percutaneous closure of RSVA is an alternative to
open surgical repair with a good success rate. RSVA with multiple fistulae
or concomitant VSD or ASD can also be managed successfully via
percutaneous approach. Patients had significant decreased duration of
hospital stay, lower medical expenditure, decreased need for ICU placement
and blood transfusions. Successful intervention has also been shown to
decrease the enlarged cardiac chamber size and improve cardiac function.
Patients should be followed up with echocardiography and monitored for any
residual shunt, recurrence, thromboembolism or aortic regurgitation.

<37>
Accession Number
71834948
Authors
Saurav A. Kaja A.K. Kaushik M. Aggarwal S. White M. Woodruff M. Mooss A.
Del Core M.
Institution
(Saurav, Kaja, Kaushik, Aggarwal, White, Woodruff, Mooss, Del Core)
Creighton University, Medical Center, Omaha, NE, United States
Title
Zotarolimus eluting stent versus everolimus eluting stent in percutaneous
coronary intervention: A meta-analysis of randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1892), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Zotarolimus eluting stents (ZES) and Everolimus eluting stents
(EES) with durable polymer are the most commonly used second and third
generation drug-eluting stents (DES) during percutaneous coronary
revascularization (PCI). Previously conducted randomized (RCTs) and
observational trials have shown variable results pertaining to their
relative efficacy including a prior meta-analysis of observational trials
showing superiority of EES. We sought to perform a meta-analysis of
published RCTs comparing ZES to EES for various the clinical outcomes at
one year. Methods: PubMed, Web of Science were searched through Sept 15th
2014 for relevant publications in English language comparing ZES with EES.
Clinical outcomes assessed at one year from procedure were all cause
death, cardiac death, myocardial infarction (MI), definite and any stent
thrombosis (ST), clinically driven target lesion revascularization (TLR),
clinically driven target vessel revascularization (TVR), major adverse
cardiac events (MACE: composite of death/MI/clinically driven TLR) and
target lesion failure rate (TLF: composite of cardiac death/ target vessel
related MI/clinically driven TLR). Study quality, publication bias,
heterogeneity were assessed. Random effect model used for data analysis.
Results: Five RCTs with 9847 patients (ZES: 4295, EES: 5552) satisfying
the study criteria were included for analysis. Mean age (ZES: 64.2, EES:
64.3 years) and gender distribution (Males: ZES 71.7%, EES 72.5%) were
similar in both groups. There was no significant difference in the
clinical outcomes like all cause death (RR= 0.92 CI: 0.63-1.34 p=0.67),
cardiac death (RR= 0.97 CI: 0.68-1.38 p=0.85), MI (RR= 1.07 CI: 0.9-1.28
p=0.44), definite ST(RR= 1.59 CI: 0.60-4.21 p=0.34), any ST(RR= 1.24 CI:
0.88-1.75 p=0.21), TLR(RR= 1.18 CI: 0.93-1.51 p=0.17), TVR(RR= 1.05 CI:
0.83-1.34 p=0.66), MACE (RR= 1.09 CI: 0.91-1.30 p=0.34) and TLF(RR= 1.07
CI: 0.90-1.27 p=0.44) between ZES and EES groups at one year. Conclusion:
In this first reported meta-analysis of RCTs, we found that ZES and EES
have equivalent safety and efficacy in terms of various clinical outcomes
at one year and hence can be used interchangeably during PCI.

<38>
Accession Number
71834934
Authors
Spinetto P.V. Briceno D. Mignatti A. Al-Bawardy R. Villablanca S. Slovut
D.
Institution
(Spinetto, Briceno, Mignatti, Al-Bawardy, Villablanca, Slovut) Montefiore
Medical Center/Albert Einstein College of Medicine, New York, NY, USA,
Universidad De Valparaiso, Valparaiso, Chile
Title
Transcatheter aortic valve replacement versus surgical aortic valve
replacement for severe aortic stenosis: Meta-analysis of randomized
controlled trials.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1878), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
alternative to surgical aortic-valve replacement (SAVR) for high-risk
patients with severe aortic stenosis (AS). Our objective was to evaluate
the efficacy and safety of TAVR compared with SAVR in high-risk patients
with AS. Methods: We conducted electronic searches of randomized
controlled trials (RCT). The primary endpoint was all-cause mortality.
Secondary endpoints were myocardial infarction (MI), stroke, major
bleeding, vascular complications, aortic regurgitation (AR), acute kidney
injury (AKI) and permanent pacemaker implantation (PPM). Odds ratios (OR)
and 95% confidence intervals (CI) computed using the Mantel-Haenszel (MH)
method. Fixed-effect model was used; if heterogeneity (I2)>40, effects
were obtained using a random model. Results: Three RCT (STACCATO, PARTNER
B and Core Valve) were included, with a total of 1,516 patients. No
difference was found for all-cause mortality at 30-days and 1-year follow
up (Figure). We only identified significant difference in the incidence of
vascular complications (OR 3,56 [95% CI 2.12-5.97], p <0.001) and PPM (OR
1.97 [95% CI 1.39-2.79], p <0.001) with TAVR. SAVR patients experienced
higher major bleeding (OR 0.63 [95% CI 0.49-0.8], p <0.001). Exclusion of
a single study from the analysis did not alter the overall result.
Conclusion: Our meta-analysis showed that TAVR as effective as SAVR in
high-risk patient with AS. Each intervention convenes its own significant
complications.

<39>
Accession Number
71834891
Authors
Gaba S. Bajaj N. Aggarwal H. Bhatia V. De Puy F. Mack M. Holmes D. Alli O.
Institution
(Gaba, Bajaj, Aggarwal, Bhatia, De Puy, Mack, Holmes, Alli) University of
Alabama at Birmingham, Birmingham, AL, United States
Title
A comparative meta-analysis for long-term stroke in patients receiving
edwards-sapien versus corevalve.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1835), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Stroke has emerged as an ominous complication after
transcatheter aortic valve replacement. While short-term stroke risk of
this procedure has been studied, long-term stroke risk with different
valve types is not defined. We performed a comprehensive metaanalysis to
compare long-term risk of two commonly used transcatheter aortic valves.
Methods: We searched SCOPUS since inception to July 2014 using predefined
criteria. Sixteen studies were eligible for our analysis. Standard
meta-analytic methods were used to compare stroke rates among
Edwards-SAPIEN (ES) and CoreValve (CV) groups at longterm follow up.
Results: Among 8 studies, 4,480 ES valves were implanted in 4,542
patients. In the CV group, among 8 studies 1,408 valves were implanted in
1,409 patients. Patients were followed for 5,377 person years in ES vs
2276 person years in CV group. Mean follow was 1.7 years (1-3.8 years) in
ES group and 1.4 years (1-2.6 years) in the CV group. During the follow
up, stroke rate in the ES group was 4.5% (95% CI: 3.3-6.2) vs 6.5% (95%
CI: 3.9-10.7) in the CV group, p=0.247. (Figure 1) Conclusion: Our
analysis suggests that both Edwards-SAPIEN and CoreValve have similar
stroke rates over long term follow up. (Table Presented).

<40>
Accession Number
71834782
Authors
Bajaj N.S. Gaba S. Aggarwal H. Bhatia V. De Puy F. Mack M. Holmes D. Alli
O.
Institution
(Bajaj, Gaba, Aggarwal, Bhatia, De Puy, Mack, Holmes, Alli) University of
Alabama at Birmingham, Birmingham, AL, USA, Birmingham, AL, USA
Title
Cerebrovascular events (CVE) post transcatheter aortic valve
replacement(TAVR): A comprehensive meta-analysis and meta-regression.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1726), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: CVE following TAVR remains a significant and dreaded
complication. The timeline and predictors for these events are not yet
defined. Methods: We searched SCOPUS since inception to July 2014 using
predefined criteria. The CVE rates were estimated at different time points
using standard meta-analytic methods; meta-regression was performed to
explore the heterogeneity. Results: Among 24 eligible studies with 11,052
patients, 10,923 valves were placed (Edwards-SAPIEN: 68%, CoreValve: 31%,
others: 1%) during 10924-person years [mean 1.5 years (range:0.3-3.8
years)] of follow up. Adjusted stroke rates (95% CIs) at 30 day, 1 year
and at completion of follow up were: 3.5% (2.9-4.2), 5.2% (4.4-6.1) and
5.3% (4.4-6.3) respectively. Figure 1, Panel B demonstrates major stroke
rate occurred early and remained constant over follow up. However, minor
stroke and transient ischemic attack rates increased over follow up. Meta-
regression demonstrated an interaction between prevalent atrial
fibrillation (AF) and stroke rate such that studies with higher prevalence
of AF had higher stroke rate at 30 days and long-term follow up (0.03 and
0.04 increase in Logit stroke rate for every 10% increase in prevalent AF,
p=0.02 and 0.003, resp.). Conclusion: There is an increased early hazard
of stroke post TAVR that continues to increase over the follow up period.
Prevalent atrial fibrillation appears to be positively associated with
increased stroke rate post TAVR during first 30 days and also at long term
follow up.

<41>
Accession Number
71834747
Authors
Christakopoulos G. Christopoulos G. Carlino M. Jeroudi O. Roesle M. Rangan
B. Abdullah S. Grodin J. Kumbhani D. Vo M. Luna M. Alaswad K. Karmpaliotis
D. Rinfret S. Garcia S. Banerjee S. Brilakis E.
Institution
(Christakopoulos, Christopoulos, Carlino, Jeroudi, Roesle, Rangan,
Abdullah, Grodin, Kumbhani, Vo, Luna, Alaswad, Karmpaliotis, Rinfret,
Garcia, Banerjee, Brilakis) VA North Texas Health Care System, Dallas, TX,
USA, University of Texas Southwestern Medical Center, Dallas, TX, USA
Title
Clinical outcomes of patients undergoing percutaneous coronary chronic
total occlusion interventions: A weighted meta-analysis of 28,486 patients
from 25 studies.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1691), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Objectives: We performed a weighted meta-analysis of the outcomes of
successful vs. failed chronic total occlusion (CTO) percutaneous coronary
intervention (PCI). Background: There are no randomized-controlled trials
on clinical outcomes following CTO PCI, limiting the available evidence to
observational cohort studies. Methods: We conducted a meta-analysis of
studies published between 1990 and 2014 reporting long-term outcomes of
successful vs. failed CTO PCI. We collected data on mortality, subsequent
coronary artery bypass graft surgery(CABG), myocardial infarction(MI),
major adverse cardiac events(MACE), angina, stroke, and target vessel
revascularization(TVR) using random effects models. Results: A total of 25
studies with 28,486 patients (29,315 CTO PCI procedures) were included.
Procedural success was 71% (range 51 - 86.8%). During a weighted mean
follow-up of 3.11 years, compared with failure, CTO PCI success was
associated with lower mortality (odds ratio [OR] 0.54, 95% CI:0.48-0.66,
Figure 1), less recurrent angina (OR = 0.36, 95% CI 0.15, 0.85), lower
risk for stroke (OR = 0.72, 95% CI 0.60, 0.88), less need for subsequent
CABG(OR = 0.18, 95% CI 0.14, 0.22), and lower risk for MACE (0.55, 95% CI
0.43, 0.71). There was no difference in TVR (OR = 0.66, 95% CI 0.36, 1.23)
or myocardial infarction (OR 0.76, 95% CI 0.54, 1.07). Conclusion:
Compared with failed procedures, successful CTO PCI procedures are
associated with a lower risk of death, stroke and CABG, and less recurrent
angina. (Table presented).

<42>
Accession Number
71834475
Authors
Briasoulis A. Mostafa A. Siddiqui F. Afonso L.
Institution
(Briasoulis, Mostafa, Siddiqui, Afonso) Wayne State University, Detroit
Medical Center, Division of Cardiology, Detroit, MI, United States
Title
Prevention of recurrent pericarditis with colchicine: An updated
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1418), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Colchicine has been suggested to be beneficial in preventing
recurrent pericarditis. The goal of this study was to review all
randomized controlled trials that assess the effects of colchicine to
prevent recurrence of pericarditis or post-pericardiotomy syndrome.
Methods: We performed a meta-analysis of the effect of colchicine versus
conventional treatment on pericarditis recurrence, medication
discontinuation and adverse events. We conducted an EMBASE and MEDLINE
search for prospective randomized, controlled trials . Results: We
identified 7 prospective randomized studies with 809 patients in the
colchicine group and 826 in the conventional treatment group. Our analysis
showed that colchicine is associated with reduced risk of pericarditis
recurrence, with homogenous results across three clinical settings
(Figure). However, mainly driven by the results of the COPPS-2 trial
colchicine was associated with more adverse events and higher rates of
discontinuation in the post-pericardiotmy subgroup analysis. Colchicine
was not associated with significantly higher rates of adverse events and
drug withdrawals when used for secondary prevention of pericarditis.
Diarrhea was the main adverse event of colchicine. (Table presented)
Conclusion: Colchicine appears to be efficacious and well tolerated for
recurrent pericarditis and should be considered a first-line agent.
However, its efficacy post-cardiac surgery is limited by adverse events .

<43>
Accession Number
71834381
Authors
Dudzinski D.M. Isselbacher E. Bhatia R. Picard M. Weiner R.
Institution
(Dudzinski, Isselbacher, Bhatia, Picard, Weiner) Massachusetts General
Hospital, Boston, MA, United States
Title
Educational intervention reduced the rate of "rarely appropriate"
outpatient transthoracic echocardiograms ordered by attending
cardiologists: A randomized controlled trial.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A1324), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Appropriate Use Criteria (AUC) for transthoracic
echocardiography (TTE) provide a framework to assess appropriate versus
less appropriate utilization. We previously conducted a randomized trial
demonstrating that an AUC-based educational intervention successfully
reduced "rarely appropriate" (rA) outpatient TTEs ordered by cardiology
fellows. It is unknown if this type of intervention would be successful as
applied to attending cardiologists. Methods: We conducted a prospective,
randomized controlled trial of an educational intervention designed to
reduce rA outpatient TTEs ordered by attending cardiologists. We
randomized 65 staff cardiologists at an academic medical center to an
AUC-based educational intervention or to a control group. The intervention
consisted of an introductory lecture and monthly email feedback. Feedback
reports documented the percentage of rA TTEs and AUC rationale for that
classification. The primary outcome was the rate of rA TTEs. Results:
96.8% of the 3,165 TTEs were classifiable by 2011 AUC. The proportion of
rA TTEs was significantly lower in the intervention versus control group
(10.9% vs. 16.5%, p=0.03), and the proportions of appropriate (77.7% vs.
72.0%, p=0.07) and uncertain TTEs (11.4% vs. 11.5%, p=0.40) were similar.
For all TTEs, the most common rA indications were: routine surveillance of
prosthetic valve < 3 years (16.9%), routine <1 year surveillance of
moderate or severe native valvular stenosis without a clinical change
(14.8%), routine <1 year surveillance of known cardiomyopathy without a
clinical change (10.4%), and routine surveillance of ventricular function
with known CAD without a clinical change (8.3%). Conclusion: An AUC-based
educational intervention significantly reduced the proportion of rA
outpatient TTEs ordered by staff cardiologists. Scheduled provider-level
feedback may represent a viable strategy to improve practice patterns and
optimize utilization of outpatient TTE. Since more than half of rA TTEs
were for routine surveillance of cardiac conditions in absence of clinical
change, focusing educational efforts on these scenarios may improve
attending cardiologist adherence to AUC-based practices.

<44>
Accession Number
71833875
Authors
Cho J.H. Hernandez A. Pasupuleti V. Deshpande A. Nagarajan V. Bueno H.
Ioannidis J. Boersma E.H. Kaw R.
Institution
(Cho, Hernandez, Pasupuleti, Deshpande, Nagarajan, Bueno, Ioannidis,
Boersma, Kaw) Cleveland Clinic, Cleveland, OH, United States
Title
Impact of diastolic dysfunction on post-operative outcomes after cardiac
surgery: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A818), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: The impact of diastolic dysfunction, found on pre-operative
echocardiogram, on post-operative mortality and complications after
cardiac surgery has been investigated only in small studies and the
results have been controversial. Methods: We searched for articles which
investigated the prognostic role of diastolic dysfunction on cardiac
surgery in PubMed, Cochrane Library, Web of Science, Embase and Scopus
until August 2014. A total of 14 studies were included in our
meta-analysis. The primary outcome was post-operative mortality and the
secondary outcomes were major adverse cardiac events (MACE), myocardial
infarction (MI), atrial fibrillation (AF) and prolonged mechanical
ventilation. Due to scarcity of outcome events, fixed-effects
meta-analysis was performed using the Mantel-Haenszel method. Results:
Diastolic dysfunction on pre-operative echocardiogram was associated with
higher post-operative mortality (OR 2.04, 95% CI 1.29-3.25; p=0.002), MACE
(OR 1.86, 95% CI 1.32-2.63; p= 0.004) and prolonged mechanical ventilation
(OR 2.08, 95% CI 1.04-4.16; p=0.04) among patients who underwent cardiac
surgery. Post-operative MI and AF did not differ between the two groups.
In a subgroup analysis, decreased left ventricular ejection fraction
(LVEF) among patients with diastolic dysfunction, did not impact
post-operative mortality (p= 0.32; I2=0%) when compared to patients with
normal LVEF and diastolic dysfunction. Severity of pre-operative diastolic
dysfunction was associated with increased post-operative mortality (OR
21.22, 95% CI 3.74-120.33; p=0.0006) and MACE (OR 5.15, 95% CI 2.90-9.14;
p<0.00001) for Grade 3 diastolic dysfunction compared to patients with
normal diastolic function. Due to scarcity of studies, subgroup analysis
by type of cardiac surgery (CABG vs. CABG with valvular surgery) and type
of echocardiogram (transthoracic vs. transeophageal) could not be done.
Conclusion: Presence of diastolic dysfunction on pre-operative
echocardiogram was associated with higher post-operative mortality and
MACE regardless of LVEF. Mortality and MACE were significantly higher in
Grade III diastolic dysfunction.

<45>
Accession Number
71833433
Authors
Lee J.Z. Singh N. Huang J. Howe C. Ortega G. Golestani S. Low S.W. Lee K.
Pandit A.
Institution
(Lee, Singh, Huang, Howe, Ortega, Golestani, Low, Lee, Pandit) University
of Arizona, Tucson, AZ, USA, DeBakey Heart Institute, Hays, KS, USA
Title
Colchicine for prevention of post-procedural atrial fibrillation: A
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A376), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Pro-inflammatory processes induced during invasive cardiac
procedures may contribute towards post-procedural atrial fibrillation.
Colchicine is a potent anti-inflammatory agent, which may have a role in
post-procedural atrial fibrillation prevention. This metaanalysis aims to
assess the role of colchicine in post-procedural prevention of atrial
fibrillation. Methods: We searched PubMed, EMBASE, Web of science and the
Cochrane Central Register of Controlled Trials databases for randomized
controlled trials (RCT) comparing colchicine versus placebo for prevention
of post-procedural atrial fibrillation. Our main outcome was the
occurrence of atrial fibrillation within 1 to 3 months post procedure,
which included cardiac surgery or pulmonary vein isolation. The overall
risk ratio (RR) for the development of post-procedural atrial fibrillation
was computed using a random-effects model. Results: Data analyzed from 5
randomized studies with a total of 1,369 patients, 641 patients received
colchicine and 638 patients received placebo, showed that colchicine
therapy was associated with a reduction of post-procedural atrial
fibrillation (MH-RR=0.63, 95% CI: 0.51-0.78, p<0.0001). Conclusion:
Colchicine therapy leads to a significant reduction in post-procedural
atrial fibrillation, and may be considered as adjunctive prophylaxis.
(Figure presented).

<46>
Accession Number
71833325
Authors
Salih M. Smer A. Elmasry Y. Mlatoum H. Spinetto P.V.
Institution
(Salih, Smer, Elmasry, Mlatoum, Spinetto) St Luke's Hospital,
Chesterfield, MO, USA, Creighton University, Omaha, NE, USA
Title
Colchicine for prevention of postoperative atrial fibrillation:
Meta-analysis of randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A268), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common medical
problem with estimated incidence up to 60% in cardiac surgery. Several
drugs have been evaluated for the prevention of POAF including amiodarone,
beta blaokers, magnesium, statins and colchicine. However, there have been
conflicting studies supporting colchicine as an effective drug for
prevention of POAF. A meta-analysis of randomized controlled trials (RCT)
was conducted comparing colchicine versus placebo to evaluate the
reduction in the rate of POAF. Methods: We conducted a comprehensive
search of PubMed, Ovid Medline, and Cochrane library database for
randomized control trials (RCT), using terms ''colchicine, postoperative
atrial fibrillation'. The primary endpoint was POAF. The safety end point
was any side effects. Odds ratios (OR) and 95% confidence intervals (CI)
computed using the Mantel-Haenszel method. Fixed-effect model was used.
Results: A total of three RCT were included in the meta-analysis,
enrolling a total of 857 patients. Colchicine significantly reduced the
rate of POAF (OR 0.579; 95% CI, 0.423-0.792, P = 0.001, I2 = 17.9) but
when compared with the placebo, the risk of side effects was higher with
colchicine (OR 2.080; 95% CI, 1.328-3.257, P = 0.001, I2= 0). The Number
need to treated was 10 and Number needed to harm was 15, with net positive
balance Conclusion: Colchicine is an effective drug for prevention of POAF
with relatively higher side effects when compared to placebo.

<47>
Accession Number
71833301
Authors
Liu W. Zhou Y.
Institution
(Liu, Zhou) An Zhen Hospital, Capital Medical University, Beijing, China
Title
How soon can off-pump coronary artery bypass graft surgery be performed
after clopidogrel discontinuation to minimize bleeding risk?.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A244), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Perioperative clopidogrel use increases bleeding risk and
blood transfusion requirement of off-pump coronary artery bypass graft
surgery (OPCAB). This study determined optimal preoperative clopidogrel
discontinuation timing based on rates of major bleeding, perioperative
ischemic events and long-term outcomes. Methods: Comparison of major
bleeding rates at consecutive days between groups A (675 patients off
clopidogrel 7 days) identified day 4 pre-OPCAB as clopidogrel
discontinuation cutoff to avoid increased bleeding risk. Primary (major
bleeding, reoperation, and multiple-type blood transfusions), and
secondary (in hospital ischemic events [acute myocardial
infarction/stroke], and in-hospital and 1-year mortality) outcomes were
compared among propensity score-matched subgroups A1 (1-4 days off drug)
and A2 (5-7 days), and group B. Predictors of post-OPCAB major bleeding
were determined by multivariable regression analysis. Results: Relative to
group B, only subgroup A1 but not subgroup A2 was at increased risk for
major bleeding (odds ratio: 1.666 [95% confidence interval=1.093-2.541],
p=0.018), reoperation (3.747 [1.171-11.982], p= 0.026) and multiple-type
blood transfusion (1.929 [1.440- 2.583], p<0.001). Subgroup A1 timing,
weight, systolic blood pressure, and low ejection fraction were predictors
for major bleeding. Inhospital ischemic event and 1-year mortality rates
did not differ significantly among groups. Conclusion: A minimal 4-day
waiting period post clopidogrel discontinuation appears optimal before
OPCAB to minimize bleeding risk. This cutoff was further substantiated by
meta-analysis of published studies.

<48>
Accession Number
71833272
Authors
Alam S. Zamvar V. Pessotto R. Steff L. Dweck M. Colin M. Semple S. Wiedow
O. Mills N. Shah A. Stirrat C. Mirsadraee S. Newby D. Henriksen P.
Institution
(Alam, Zamvar, Pessotto, Steff, Dweck, Colin, Semple, Wiedow, Mills, Shah,
Stirrat, Mirsadraee, Newby, Henriksen) University of Edinburgh, Edinburgh,
United Kingdom
Title
Peri-operative elafin for ischaemia reperfusion injury during coronary
artery bypass graft/cardiac surgery.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A215), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: Elafin is a neutrophil elastase inhibitor that protects
against myocardial injury in pre-clinical models of ischemic-reperfusion
injury. We investigated if elafin could inhibit myocardial injury induced
during coronary artery bypass graft (CABG) surgery. Methods: In a
randomized double blind placebo controlled clinical trial, 87 patients
undergoing CABG surgery were randomized 1:1 to Elafin 200 mg or saline
placebo. Myocardial injury was measured as cardiac troponin I release over
48 h (area under the curve, AUC) and myocardial infarction (MI) identified
by magnetic resonance imaging. Inflammation was measured by hs-CRP, and
myeloperoxidase (MPO) assays. Results: Elafin infusion was associated with
a >50% reduction in plasma elastase activity, but this did not reduce
myocardial injury over 48 h compared to placebo [ratio of geometric mean
troponin 0.74 (95% confidence interval, CI 0.47 to 1.15), P=0.18]. Post
hoc analysis revealed lower troponin I concentrations at 6 h in elafin
treated patients (median 2.4 versus 4.1 mug/L, P=0.035). Elafin had no
effect on rates of peri-operative MI (elafin 7/34, placebo 5/35 patients)
or inflammation with mean differences in hs-CRP of 499 mg/L/48-h (95% CI
-207 to 1205, P=0.16), and AUC MPO of 238 ng/mL/48-h (95% CI -235 to 711,
P=0.32). Conclusion: We didn't show a difference with elafin treatment in
myocardial injury following ischemia-reperfusion injury. Post-hoc analysis
revealed a significant reduction in Troponin release at 6 h after skin
incision. (Figure Presented).

<49>
Accession Number
71833268
Authors
Spanuchart I. Cheungpasitporn W. Thongprayoon C. Ratanapo S. Srivali N.
Institution
(Spanuchart, Cheungpasitporn, Thongprayoon, Ratanapo, Srivali) John A.
Burns School of Medicine, University of Hawaii, Honolulu, HI, USA,
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
Title
Off-pump versus on-pump coronary artery bypass surgery: An updated
meta-analysis of randomized controlled trials on acute kidney injury and
mortality outcomes.
Source
Journal of the American College of Cardiology. Conference: 64th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.15 San Diego, CA United States. Conference
Start: 20150314 Conference End: 20150316. Conference Publication:
(var.pagings). 65 (10 SUPPL. 1) (pp A211), 2015. Date of Publication: 17
Mar 2015.
Publisher
Elsevier USA
Abstract
Background: The risk of acute kidney injury (AKI) in patients undergoing
coronary artery bypass surgery (CABG) with on-pump and offpump techniques
for ischemic heart disease is controversial. The objective of this
meta-analysis was to compare these two techniques with respect to causing
AKI. Methods: Comprehensive literature searches for randomized controlled
trials (RCTs) of CABG with on-pump and off-pump was performed using
MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central
Register of Controlled Trials Systematic Reviews and clinicaltrials.gov
from inception through August 2014. Primary outcome was the incidence of
AKI. Results: Thirty one prospective RCTs (11,851 patients) were included
in our analysis. By meta-analysis, patients in off-pump CABG group had
overall lower incidence of AKI (19.1%) compared to on-pump CABG group
(22.2%). There was a significant protective effect of offpump CABG on the
incidence of AKI compared to on-pump CABG group [risk ratios (RR): 0.87;
95% CI: 0.77-0.98, I2 of 5%]. The post hoc analysis assessing the
mortality outcome demonstrated pooled RR of 0.97 (95% CI, 0.77-1.23) in
off-pump vs on-pump CABGs. Conclusion: Our study demonstrates
significantly beneficial effect of off-pump CABG on the incidence of AKI
compared to conventional on-pump CABG. However, our meta-analysis does not
show survival benefit among patients undergoing CABG. (Table Presented).